Report on the Iowa Lottery Authority for the period July 1, 2002 through June 30, 2010

Report on the Iowa Lottery Authority for the period July 1, 2002 through June 30, 2010

Agreed upon procedures report on the Iowa Sheep and Wool Promotion Board for the period July 1, 2009 through June 30, 2011

Agreed upon procedures report on the Iowa Sheep and Wool Promotion Board for the period July 1, 2009 through June 30, 2011

Report on a review of selected application controls over the Iowa Department of Transportation’s Driver’s License System for the period May 2, 2011 through May 27, 2011

Report on a review of selected application controls over the Iowa Department of Transportation’s Driver’s License System for the period May 2, 2011 through May 27, 2011

Report on a special investigation of the Sunrise Sunset Daycare of the Southeast Warren Community School District for the period September 1, 2010 through September 26, 2011

Report on a special investigation of the Sunrise Sunset Daycare of the Southeast Warren Community School District for the period September 1, 2010 through September 26, 2011

Report on a review of selected application controls over the Iowa State University of Science and Technology Facilities Planning and Management - Facilities Administrative Management Information System for the period of April 18, 2011 through May 16, 2011

Report on a review of selected application controls over the Iowa State University of Science and Technology Facilities Planning and Management - Facilities Administrative Management Information System for the period of April 18, 2011 through May 16, 2011

Report on a special investigation of the Starmont Community School District for the period July 1, 1993 through November 30, 2010

Report on a special investigation of the Starmont Community School District for the period July 1, 1993 through November 30, 2010

Report on a review of selected general and application controls over the Iowa Department of Human Services’ Medicaid Management Information System for the period April 4, 2011 through April 29, 2011

Report on a review of selected general and application controls over the Iowa Department of Human Services’ Medicaid Management Information System for the period April 4, 2011 through April 29, 2011

Agreed upon procedures report on the six Library Service Areas in the State of Iowa for the period July 1, 2010 through June 30, 2011

Agreed upon procedures report on the six Library Service Areas in the State of Iowa for the period July 1, 2010 through June 30, 2011

Agreed upon procedures report on the Lee County Narcotics Task Force for the period July 1, 2010 through May 31, 2012

Agreed upon procedures report on the Lee County Narcotics Task Force for the period July 1, 2010 through May 31, 2012

Intraoperative training on the techniques of sentinel node biopsy in breast cancer

Principles: Surgeon's experience is crucial for proper application of sentinel node biopsy (SNB) in patients with breast cancer. A 20-30 cases learning curve of sentinel node (SN) and axillary lymph node dissection (ALND) was widely practiced. In order to speed up this learning curve, surgeons may be trained intraoperative by an experienced surgeon. The purpose of this report is to evaluate the results of this procedure. Methods: Patients with one primary invasive breast cancer (cT1-T2[<3 cm]cN0) underwent SNB based on lymphoscintigraphy using technetium Tc 99m colloid, intraoperative gamma probe detection, with or without blue dye mapping. This was followed by completion ALND when SN was positive or not found. SNB was performed by one experienced surgeon (teacher) or by 10 junior surgeons trained by the experienced surgeon (trainees). Four groups were defined: (i) SNB with immediate ALND for the teacher's learning curve, (ii) SNB by the teacher, (iii) SNB by the trainees under the teacher's supervision, and (iv) SNB by the trainees alone. Results: Between May 1999 and December 2007, a total of 808 évaluable patients underwent SNB. The SN identification rate was 98% in the teacher's group, and 99% in the trainees' group (p = 0.196). SN were positive in respectively 28% and 29% of patients (p = 0.196). The distribution of isolated tumor cells, micrometastases and metastases was not statistically different between the teacher's and the trainees' groups (p = 0.163). Conclusion: These comparable results confirm the success with which the SNB was taught. This strategy avoided the 20-30 SNB followed by immediate ALND early required per surgeon.

A CT-based study investigating the relationship between pedicle screw placement and stimulation threshold of compound muscle action potentials measured by intraoperative neurophysiological monitoring.

PURPOSE: Neurophysiological monitoring aims to improve the safety of pedicle screw placement, but few quantitative studies assess specificity and sensitivity. In this study, screw placement within the pedicle is measured (post-op CT scan, horizontal and vertical distance from the screw edge to the surface of the pedicle) and correlated with intraoperative neurophysiological stimulation thresholds. METHODS: A single surgeon placed 68 thoracic and 136 lumbar screws in 30 consecutive patients during instrumented fusion under EMG control. The female to male ratio was 1.6 and the average age was 61.3 years (SD 17.7). Radiological measurements, blinded to stimulation threshold, were done on reformatted CT reconstructions using OsiriX software. A standard deviation of the screw position of 2.8 mm was determined from pilot measurements, and a 1 mm of screw-pedicle edge distance was considered as a difference of interest (standardised difference of 0.35) leading to a power of the study of 75 % (significance level 0.05). RESULTS: Correct placement and stimulation thresholds above 10 mA were found in 71 % of screws. Twenty-two percent of screws caused cortical breach, 80 % of these had stimulation thresholds above 10 mA (sensitivity 20 %, specificity 90 %). True prediction of correct position of the screw was more frequent for lumbar than for thoracic screws. CONCLUSION: A screw stimulation threshold of >10 mA does not indicate correct pedicle screw placement. A hypothesised gradual decrease of screw stimulation thresholds was not observed as screw placement approaches the nerve root. Aside from a robust threshold of 2 mA indicating direct contact with nervous tissue, a secondary threshold appears to depend on patients' pathology and surgical conditions.

Special investigation of the City of Scarville for the period January 1, 2006 through March 31, 2011

Special investigation of the City of Scarville for the period January 1, 2006 through March 31, 2011

Report on applying agreed-upon procedures of Kossuth Connections, Algona, Iowa, and the Iowa Commission on Volunteer Services within the Iowa Department of Economic Development, now known as the Iowa Economic Development Authority, for the period October 2010 through June 2011

Report on applying agreed-upon procedures of Kossuth Connections, Algona, Iowa, and the Iowa Commission on Volunteer Services within the Iowa Department of Economic Development, now known as the Iowa Economic Development Authority, for the period October 2010 through June 2011

Report on the Chariton Valley Planning & Development Council of Governments for the period July 1, 2007 through August 31, 2010

Report on the Chariton Valley Planning & Development Council of Governments for the period July 1, 2007 through August 31, 2010

Report on a special investigation of the City of Bloomfield Volunteer Fire Department for the period July 1, 2006 through June 30, 2010

Report on a special investigation of the City of Bloomfield Volunteer Fire Department for the period July 1, 2006 through June 30, 2010