2012 Annual Report for Appropriations from the Rebuild Iowa Infrastructure Fund and Revenue Bonds Capitals II Fund to the Watershed Improvement Fund

The Watershed Improvement Fund and the Watershed Improvement Review Board (WIRB) were created in 2005. This statute is now codified in Iowa Code Chapter 466A. The purpose of the Watershed Improvement Fund is to enlmnce the water quality and flood prevention efforts in the state through a variety of impairment-based, locally­ directed watershed improvement projects. These projects are awarded grants through a competitive application process directed by the WIRB. Appropriations to the Fund do not revert except for the Capital Revenue Bonds II (RCB2) appropriation. Interest eamed on the moneys on the Fund are also retained in the Fund and are used to fund projects or pay per diem and expenses of the WIRB members. Starting July 1, 2012, the Fund is also receiving Animal Agriculture Compliance Fund Penalties. In state fiscal years 2009 (SFY2009) and 2010 (SFY2010), the Watershed Improvement Fund was appropriated $5,000,000 from the Rebuild Iowa Infrastructure Fund (RIIF). In SFY2011, the Watershed Improvement Fund was appropriated $2,000,000 from the Revenue Bonds Capitals II Fund (RBC2). No appropriation was received in fiscal year 2012. In SFY 2013, the Watershed Improvement Fund was appropriated $1,000,000 from the RIIF.

2013 Annual Report for Appropriations from the Rebuild Iowa Infrastructure Fund and Revenue Bonds Capitals II Fund to the Watershed Improvement Fund

The Watershed Improvement Fund and the Watershed Improvement Review Board (WIRB) were created in 2005. This statute is now codified in Iowa Code Chapter 466A. The purpose of the Watershed Improvement Fund is to enhance the water quality in the state through a variety of impairment-based, locally-directed watershed improvement projects. These projects are awarded grants through a competitive application process directed by the WIRB. Appropriations to the Fund do not revert except for the Capital Revenue Bonds II (RCB2) appropriation. Interest earned on the moneys on the Fund are also retained in the Fund and are used to fund projects or pay per diem and expenses of the WIRB members. Starting July 1, 2012, the Fund is also receiving Animal Agriculture Compliance Fund Penalties. In state fiscal years 2009 (SFY2009) and 2010 (SFY2010), the Watershed Improvement Fund was appropriated $5,000,000 from the Rebuild Iowa Infrastructure Fund (RIIF). In SFY2011, the Watershed Improvement Fund was appropriated $2,000,000 from the Revenue Bonds Capitals II Fund (RBC2). No appropriation was received in fiscal year 2012. In SFY 2013, the Watershed Improvement Fund was appropriated $1,000,000 from the RIIF.

2014 Annual Report for Appropriations from the Rebuild Iowa Infrastructure Fund and Revenue Bonds Capitals II Fund to the Watershed Improvement Fund

The Watershed Improvement Fund and the Watershed Improvement Review Board (WIRB) were created in 2005. This statute is now codified in Iowa Code Chapter 466A. The purpose of the Watershed Improvement Fund is to enhance the water quality in the state through a variety of impairment-based, locally-directed watershed improvement projects. These projects are awarded grants through a competitive application process directed by the WIRB. Appropriations to the Fund do not revert except for the Capital Revenue Bonds II (RCB2) appropriation. Interest earned on the moneys on the Fund are also retained in the Fund and are used to fund projects or pay per diem and expenses of the WIRB members. Starting July 1, 2012, the Fund is also receiving Animal Agriculture Compliance Fund Penalties. In state fiscal years 2009 (SFY2009) and 2010 (SFY2010), the Watershed Improvement Fund was appropriated $5,000,000 from the Rebuild Iowa Infrastructure Fund (RIIF). In SFY2011, the Watershed Improvement Fund was appropriated $2,000,000 from the Revenue Bonds Capitals II Fund (RBC2). No appropriation was received in fiscal year 2012. In SFY 2013, the Watershed Improvement Fund was appropriated $1,000,000 from the RIIF.

Evaluation of Iowa's Driver Improvement Program, 2009

This study examines the effectiveness of Iowa’s Driver Improvement Program (DIP), measured as the reduction in the number of driver convictions subsequent to the DIP. The analysis involved a random sample of 9,055 drivers who had been instructed to attend DIP and corresponding data on driver convictions, crashes, and driver education training history that were provided by the Iowa Motor Vehicle Division. The sample was divided into two groups based on DIP outcome: satisfactory or unsatisfactory completion. Two evaluation periods were considered: one year after the DIP date (probation period) and the period from the 13th to 18th month after the DIP date. The evaluation of Iowa’s DIP showed that there is evidence of effectiveness in terms of reducing driver convictions subsequent to attending the DIP. Among the 6,790 (75%) drivers who completed the course satisfactorily, 73% of drivers had no actions and 93% were not involved in a crash during the probation period. Statistical tests confirmed these numbers. However, the positive effect of satisfactory completion of DIP on survival time (that is, the time until the first conviction) was not statistically significant 13 months after the DIP date. Econometric model estimation results showed that, regardless of the DIP outcome, the likelihood of conviction occurrence and frequency of subsequent convictions depends on other factors, such as age, driver history, and DIP location, and interaction effects among these factors. Low-cost, early intervention measures are suggested to enhance the effectiveness of Iowa’s DIP. These measures can include advisory and warning letters (customized based on the driver’s age) sent within the first year after the DIP date and soon after the end of the probation period, as well as a closer examination of DIP instruction across the 17 community colleges that host the program. Given the large number of suspended drivers who continued to drive, consideration should also be given to measures to reduce driving while suspended offenses.

Rapid Improvement and Maintenance of the Lipid Profile After Roux-en-Y Gastric Bypass (RYGBP)

Background: Dyslipidemia, a major component of the metabolic syndrome and an important cardiovascular risk factor, is one of the commonest comorbidity associated with morbid obesity. The aim of this paper is to show that RYGBP markedly improves dyslipidemia and that this improvement maintains over time. Patients and Methods: Prospectively updated databank for bariatric patients. Patients undergoing RYGBP have yearly blood tests during follow-up. The results for lipids at one to five years were compared with preoperative values. Results: The mean excess BMI loss after one and five years was 77,9 % and 72,3%respectively. After one year, there was a significant reduction of the mean total cholesterol, LDL-cholesterol, total cholesterol/HDL ratio and triglyceride values, which maintained up to five years, and an increase of the HDL fraction, which progressed until five years. The proportion of patients with abnormal values decreased from 24,3 to 6,2% for total cholesterol, from 45,1 to 11,7 %for HDL, from 53,3 to 21,9 for LDL, and from 40,5 to 10 % for triglycerides, with no significant change between three and five years, despite some weight regain. Conclusions: RYGBP rapidly improves all components of dyslipidemia, and thereby reduces the overall cardiovascular risk in operated patients.

Group motivational intervention in overweight/obese patients in primary prevention of cardiovascular disease in the primary healthcare area

Background The global mortality caused by cardiovascular disease increases with weight. The Framingham study showed that obesity is a cardiovascular risk factor independent of other risks such as type 2 diabetes mellitus, dyslipidemia and smoking. Moreover, the main problem in the management of weight-loss is its maintenance, if it is achieved. We have designed a study to determine whether a group motivational intervention, together with current clinical practice, is more efficient than the latter alone in the treatment of overweight and obesity, for initial weight loss and essentially to achieve maintenance of the weight achieved; and, secondly, to know if this intervention is more effective for reducing cardiovascular risk factors associated with overweight and obesity. Methods This 26-month follow up multi-centre trial, will include 1200 overweight/obese patients. Random assignment of the intervention by Basic Health Areas (BHA): two geographically separate groups have been created, one of which receives group motivational intervention (group intervention), delivered by a nurse trained by an expert phsychologist, in 32 group sessions, 1 to 12 fortnightly, and 13 to 32, monthly, on top of their standard program of diet, exercise, and the other (control group), receiving the usual follow up, with regular visits every 3 months. Discussion By addressing currently unanswered questions regarding the maintenance in weight loss in obesity/overweight, upon the expected completion of participant follow-up in 2012, the IMOAP trial should document, for the first time, the benefits of a motivational intervention as a treatment tool of weight loss in a primary care setting.

Effectiveness of pharmacist care in the improvement of adherence to antidepressants: a systematic review and meta-analysis

BACKGROUND: Pharmacists can play a decisive role in the management of ambulatory patients with depression who have poor adherence to antidepressant drugs. OBJECTIVE: To systematically evaluate the effectiveness of pharmacist care in improving adherence of depressed outpatients to antidepressants. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. RCTs were identified through electronic databases (MEDLINE, Cochrane Central Register of Controlled Trials, Institute for Scientific Information Web of Knowledge, and Spanish National Research Council) from inception to April 2010, reference lists were checked, and experts were consulted. RCTs that evaluated the impact of pharmacist interventions on improving adherence to antidepressants in depressed patients in an outpatient setting (community pharmacy or pharmacy service) were included. Methodologic quality was assessed and methodologic details and outcomes were extracted in duplicate. RESULTS: Six RCTs were identified. A total of 887 patients with an established diagnosis of depression who were initiating or maintaining pharmacologic treatment with antidepressant drugs and who received pharmacist care (459 patients) or usual care (428 patients) were included in the review. The most commonly reported interventions were patient education and monitoring, monitoring and management of toxicity and adverse effects, adherence promotion, provision of written or visual information, and recommendation or implementation of changes or adjustments in medication. Overall, no statistical heterogeneity or publication bias was detected. The pooled odds ratio, using a random effects model, was 1.64 (95% CI 1.24 to 2.17). Subgroup analysis showed no statistically significant differences in results by type of pharmacist involved, adherence measure, diagnostic tool, or analysis strategy. CONCLUSIONS: These results suggest that pharmacist intervention is effective in the improvement of patient adherence to antidepressants. However, data are still limited and we would recommend more research in this area, specifically outside of the US.

The lower quality of preventive care among forced migrants in a country with universal healthcare coverage.

OBJECTIVE: To assess the association between socio-demographic factors and the quality of preventive care and chronic care of cardiovascular (CV) risk factors in a country with universal health care coverage. METHODS: Our retrospective cohort assessed a random sample of 966 patients aged 50-80years followed over 2years (2005-2006) in 4 Swiss university primary care settings (Basel/Geneva/Lausanne/Zürich). We used RAND's Quality Assessment Tools indicators and examined recommended preventive care among different socio-demographic subgroups. RESULTS: Overall patients received 69.6% of recommended preventive care. Preventive care indicators were more likely to be met among men (72.8% vs. 65.4%; p<0.001), younger patients (from 71.0% at 50-59years to 66.7% at 70-80years, p for trend=0.03) and Swiss patients (71.1% vs. 62.7% in forced migrants; p=0.001). This latter difference remained in multivariate analysis adjusted for gender, age, civil status and occupation (OR 0.68; 95% CI 0.54-0.86). Forced migrants had lower scores for physical examination and breast and colon cancer screening (all p≤0.02). No major differences were seen for chronic care of CV risk factors. CONCLUSION: Despite universal healthcare coverage, forced migrants receive less preventive care than Swiss patients in university primary care settings. Greater attention should be paid to forced migrants for preventive care.

07008-002 Yellow River Watershed Improvement Project Final Report

Two sections of the Yellow River have been named to the State of Iowa’s 303d list of impaired waters. The listing reflects streams with pollution problems linked to habitat alterations, in addition to those with potential disease causing bacteria, viruses and parasites. This fact, combined with local knowledge of water quality problems, shows the need for land treatment practices and habitat improvement measures. This project would target the Yellow River watershed, which totals approximately 49,800 acres. Areas that drain directly into the Yellow River mainstream will be targeted. Individually, these areas are too small to be considered sub-watersheds. This project will assess the drainage areas for active gullies and prioritize grade stabilization structures based upon severity and impact on the fishery. Funding would be utilized to target high priority grade stabilization structure sites and provide cost-share for those projects. A prerequisite for cost-share allocation is 75% of the land contributing to the drainage area must have some form of treatment in place. The Allamakee SWCD has received an EPA Region 7 Grant toward grade stabilization structures in the same area. Landowners have indicated that 75% cost-share is necessary to implement practices. To meet this request, the EPA funding would be used at a 15% cost-share rate if matched with 60% cost-share from WIRB funding. If matched with Federal EQIP funds, 25% of funds obtained from WIRB would be used. If other funds were depleted, WIRB funds would be utilized for the entire 75% cost-share.

05011-055 Yellow River Watershed Improvement Project Final Report

An overall effort has been initiated to improve the quality of the Yellow River in Northeast Iowa by reducing the amount of sediment and bacteria entering the stream. Funding for this project will be utilized to improve stream quality to the level of fully supporting game fish such as brown, rainbow and brook trout, walleye, northern pike and smallmouth bass. The Yellow River has the potential to be one of the top trout streams, not only in Iowa, but in the entire Upper Midwest. This project will greatly enhance recreational activities such as fishing, canoeing and inner tubing and will greatly increase tourism dollars to the state. The project will specifically address two sources of impairment: stream bank erosion and coliform bacteria from both livestock and inadequate human septic systems.

2015 Calendar Year Annual Report of the Watershed Improvement Review Board

The Watershed Improvement Fund and the Iowa Watershed Improvement Review Board (WIRB) were created in 2005. This statute is now codified in Iowa Code Chapter 466A. The fifteen-member Board conducted seven meetings throughout the year in-person or via teleconference. Meetings were held January 23, February 27, April 17, June 18, July 24, September 25 and December 17. Attachment 1 lists the board members and their organization affiliation. The Board completed one Request For Applications (RFA) for the Watershed Improvement Fund. The RFA was announced November 6, 2014 and closed December 29, 2014. December 29, 2014 Closing Date Request For Applications: The Board received 16 applications in response to this RFA. These applications requested $2.8 million in Watershed Improvement Funds and leveraged an additional $9.1 million for a total of $11.9 million of watershed project activity proposed. After reviewing and ranking the applications individually from this RFA, the Board met and selected eight applications for funding. The eight applications were approved for $1,249,861 of Watershed Improvement Funds. Data on the eight selected projects in this RFA include the following: • These projects included portions of 12 counties. • The $1.2 million requested of Watershed Improvement Funds leveraged an additional $4.2 million for a total of $5.4 million in watershed improvements. • Approved projects ranged in funding from $41,980 to $250,000. Attachment 2 lists the approved projects’ name, applicant name, project length, county or counties where located, and funding amount for the RFA. Attachment 3 is a map showing the status of all projects funded since inception of the program. At the end of 2015 there are 111 completed projects and 39 active projects. In cooperation with the Treasurer of State, the WIRB submitted the 2015 year-end report for the Rebuild Iowa Infrastructure Fund to the Legislative Services Agency and the Department of Management. Attachment 4 contains the 2015 annual progress reports submitted from active projects or projects finished in 2015.

2015 Annual Report for Appropriations from the Rebuild Iowa Infrastructure Fund and Revenue Bonds Capitals II Fund to the Watershed Improvement Review Fund

This is the annual appropriations report submitted on behalf of the Watershed Improvement Review Board (WIRB).

Genetic improvement and population structure of the Nelore breed in Northern Brazil

The objective of this work was to evaluate the population structure and the genetic and phenotypic progress of Nelore cattle in Northern Brazil. Pedigree information concerning animals born between 1942 and 2006 were analyzed. Population structure was performed using the Endog program. Out of the 140,628 animals studied, 67.7, 14.52 and 3.18% had complete pedigree record of the first, second and third parental generation, respectively. Inbreeding and average relatedness coefficients were low: 0.2 and 0.13%, respectively. However, these parameters may have been underestimated, since information on pedigree was incomplete. The effective number of founders was 370 and the genetic contribution of 10, 50 and 448 most influent ancestors explained 13.2, 28 and 50% of the genetic variability in the population, respectively. The genetic variability for growth traits and population structure demonstrates high probability of increasing productivity through selective breeding. Moreover, management strategies to reduce the currently observed age at first calving and generation intervals are important for Nelore cattle genetic improvement.

Watershed Improvement Fund and Watershed Improvement Review Board, 2013

2013 yea end summary for the Watershed Improvement Fund.

Healthcare Power of Attorney

A health care power of attorney (HC-POA) is a document authorizing an attorney-in-fact (your designated agent) to make health care decisions on your behalf if you (the principal) are unable, in the judgment of your attending physician, to make health care decisions. Health care is defined as any care, treatment, service or procedure required to maintain, diagnose or treat a physical or mental condition. Through your HC-POA, you may authorize someone else to consent, refuse or withdraw consent to health care on your behalf. The attorney-in-fact is permitted to make only health care-related decisions on your behalf. In exercising this authority, the attorney-in-fact must act consistently with your desires (as stated in the HC-POA document).