Pediatric advance care planning: a systematic review.

BACKGROUND AND OBJECTIVES: Advance care planning (ACP) is increasingly regarded as the gold standard in the care of patients with life-limiting illnesses. Research has focused on adults, but ACP is also being practiced in pediatrics. We conducted a systematic review on empirical literature on pediatric ACP (pACP) to assess current practices, effects, and perspectives of pACP. METHODS: We searched PubMed, BELIT, and PSYCinfo for empirical literature on pACP, published January 1991 through January 2012. Titles, abstracts, and full texts were screened by 3 independent reviewers for studies that met the predefined criteria. The evidence level of the studies was assessed. Relevant study outcomes were retrieved according to predefined questions. RESULTS: We included 5 qualitative and 8 quantitative studies. Only 3 pACP programs were identified, all from the United States. Two of them were informed by adult programs. Major pACP features are discussions between families and care providers, as well as advance directives. A chaplain and other providers may be involved if required. Programs vary in how well they are evaluated; only 1 was studied by using a randomized controlled trial. Preliminary data suggest that pACP can successfully be implemented and is perceived as helpful. It may be emotionally relieving and facilitate communication and decision-making. Major challenges are negative reactions from emergency services, schools, and the community. CONCLUSIONS: There are few systematic pACP programs worldwide and none in Europe. Future research should investigate the needs of all stakeholders. In particular, the perspective of professionals has so far been neglected.

Planning-Level Guidelines for Modern Roundabouts, 2008

This technical memorandum provides preliminary planning-level guidance to engineers, technicians, planners, and policymakers who may be considering a modern roundabout at an existing or proposed intersection in Iowa.

Iowa's Maternal Health, Child Health and Family Planning Business Plan, January 2014

• Promotes access to regular preventive health care services for children through contracts with 22 agencies covering all of Iowa’s 99 counties • Fosters age appropriate growth and development by promoting early identification of children’s health concerns and referral for diagnosis and treatment • Assists families to establish medical and dental homes for their children • Targets low income families – children on Medicaid and those who are uninsured and under insured • Strives to meet family needs and remove barriers to accessing health care by linking families to community-based, culturally appropriate services

Juvenile Justice System Planning Data Iowa’s Juvenile Justice Advisory Council Three Year Comprehensive Plan with Additional Juvenile Justice System Information, November 2015

This report provides key juvenile justice system planning data, most of which are taken from Iowa’s 2015 Juvenile Justice and Delinquency Prevention Act Three Year Plan. The data and related descriptions serve as an overview of decision making for major juvenile justice system processing points, and also assist state and local officials with policy and practice. Included in the report are school discipline data and data related to juvenile in the adult criminal justice system.

Juvenile Justice System Planning Data Iowa’s Juvenile Justice Advisory Council Three Year Comprehensive Plan with Additional Juvenile Justice System Information, November 2015

This report provides key juvenile justice system planning data, most of which are taken from Iowa’s 2015 Juvenile Justice and Delinquency Prevention Act Three Year Plan. The data and related descriptions serve as an overview of decision making for major juvenile justice system processing points, and also assist state and local officials with policy and practice. Included in the report are school discipline data and data related to juvenile in the adult criminal justice system.

Watershed Planning Advisory Council 2015 Annual Report, December 10, 2015

The Watershed Planning Advisory Council (WPAC) was established by the Iowa Legislature (see Appendix A: Iowa Code 466B.31) to assemble a diverse group of stakeholders to make recommendations to state and federal agencies to protect water resources in Iowa. In 2015, WPAC prioritized the seven areas for recommendations outlined in 466B.31, and small work groups drafted recommendations for approval by the full membership.

Organization and Coordination of the Highway Planning Function in Iowa, HR-150, 1971

The Engineering Research Institute at Iowa State University studied the organization and procedures for highway planning by all levels of government and the coordination among various state agencies and local governments in Iowa. Study information was derived from interviews, questionnaires, and a review of the literature. Representatives from state transportation or highway organizations in all states responded to questionnaires. Additionally, selected upper and intermediate level personnel from highway organizations in seven other states were interviewed and a visit was made to one state transportation department. Within Iowa, employees were interviewed in the Highway Commission, Office for Planning and Programming, Development Commission, Commerce Commission, Conservation Commission, and Highway Patrol. Nearly 600 officials of local governments in Iowa contributed factual data and opinions through questionnaires and interviews. Private citizens and consultants also provided input to the investigation through their responses to questionnaires. Twelve recommendations to improve highway planning in Iowa were formulated as a result of this study.

Improved Employment Data for Transportation Planning, 1998

Transportation planners typically use census data or small sample surveys to help estimate work trips in metropolitan areas. Census data are cheap to use but are only collected every 10 years and may not provide the answers that a planner is seeking. On the other hand, small sample survey data are fresh but can be very expensive to collect. This project involved using database and geographic information systems (GIS) technology to relate several administrative data sources that are not usually employed by transportation planners. These data sources included data collected by state agencies for unemployment insurance purposes and for drivers licensing. Together, these data sources could allow better estimates of the following information for a metropolitan area or planning region: · Locations of employers (work sites); · Locations of employees; · Travel flows between employees’ homes and their work locations. The required new employment database was created for a large, multi-county region in central Iowa. When evaluated against the estimates of a metropolitan planning organization, the new database did allow for a one to four percent improvement in estimates over the traditional approach. While this does not sound highly significant, the approach using improved employment data to synthesize home-based work (HBW) trip tables was particularly beneficial in improving estimated traffic on high-capacity routes. These are precisely the routes that transportation planners are most interested in modeling accurately. Therefore, the concept of using improved employment data for transportation planning was considered valuable and worthy of follow-up research.

Ultimate Load Behavior of Full-Scale Highway Truss Bridges: Phase I - Ultimate Load Tests of the Hubby Bridge - Boone County, Interim Report, HR-169, 1975

As a result of the construction of the Saylorville Dam and Reservoir on the Des Moines River, six highway bridges crossing the river were scheduled for removal. One of these, an old pinconnected high-truss single-lane bridge, was selected for a testing program which included ultimate load tests. The purpose of the ultimate load tests, which are summarized in this report, was to relate design and rating procedures presently used in bridge design to the field behavior of this type of truss bridge. The ultimate load tests consisted of ultimate load testing of one span of the bridge, of two I-shaped floorbeams, and of two panels of the timber deck. The theoretical capacity of each of these components is compared with the results from the field tests.

Sex differences in lipid and glucose kinetics after ingestion of an acute oral fructose load.

The increase in VLDL TAG concentration after ingestion of a high-fructose diet is more pronounced in men than in pre-menopausal women. We hypothesised that this may be due to a lower fructose-induced stimulation of de novo lipogenesis (DNL) in pre-menopausal women. To evaluate this hypothesis, nine healthy male and nine healthy female subjects were studied after ingestion of oral loads of fructose enriched with 13C6 fructose. Incorporation of 13C into breath CO2, plasma glucose and plasma VLDL palmitate was monitored to evaluate total fructose oxidation, gluconeogenesis and hepatic DNL, respectively. Substrate oxidation was assessed by indirect calorimetry. After 13C fructose ingestion, 44.0 (sd 3.2)% of labelled carbons were recovered in plasma glucose in males v. 41.9 (sd 2.3)% in females (NS), and 42.9 (sd 3.7)% of labelled carbons were recovered in breath CO2 in males v. 43.0 (sd 4.5)% in females (NS), indicating similar gluconeogenesis from fructose and total fructose oxidation in males and females. The area under the curve for 13C VLDL palmitate tracer-to-tracee ratio was four times lower in females (P < 0.05), indicating a lower DNL. Furthermore, lipid oxidation was significantly suppressed in males (by 16.4 (sd 5.2), P < 0.05), but it was not suppressed in females ( -1.3 (sd 4.7)%). These results support the hypothesis that females may be protected against fructose-induced hypertriglyceridaemia because of a lower stimulation of DNL and a lower suppression of lipid oxidation.

Ultimate Load Behavior of Full-Scale Highway Truss Bridges: Phase II - Service Load and Supplementary Tests, Interim Report, HR-169, 1975

As a result of the construction of the Saylorville Dam and Reservoir on the Des Moines River, six highway bridges crossing the river were scheduled for removal. Two of these were incorporated into a comprehensive test program to study the behavior of old pin-connected high-truss single-lane bridges. The test program consisted of ultimate load tests, service load tests and a supplementary test program. The results reported in this report cover the service load tests on the two bridges as well as the supplementary tests, both static and fatigue, of eyebar members removed from the two bridges. The field test results of the service loading are compared with theoretical results of the truss analysis.

Load Testing and Load Rating Eight State Highway Bridges in Iowa, 1999

This main report provides a general discussion of the load testing, structural evaluation, and load rating procedures. Specific details for each bridge are provided in individual report sections. Additional supporting information on load testing, analyses, and load rating are also provided in the attached appendices.

Spontaneous viral clearance, viral load, and genotype distribution of hepatitis C virus (HCV) in HIV-infected patients with anti-HCV antibodies in Europe.

BACKGROUND: Variables influencing serum hepatitis C virus (HCV) RNA levels and genotype distribution in individuals with human immunodeficiency virus (HIV) infection are not well known, nor are factors determining spontaneous clearance after exposure to HCV in this population. METHODS: All HCV antibody (Ab)-positive patients with HIV infection in the EuroSIDA cohort who had stored samples were tested for serum HCV RNA, and HCV genotyping was done for subjects with viremia. Logistic regression was used to identify variables associated with spontaneous HCV clearance and HCV genotype 1. RESULTS: Of 1940 HCV Ab-positive patients, 1496 (77%) were serum HCV RNA positive. Injection drug users (IDUs) were less likely to have spontaneously cleared HCV than were homosexual men (20% vs. 39%; adjusted odds ratio [aOR], 0.36 [95% confidence interval {CI}, 0.24-0.53]), whereas patients positive for hepatitis B surface antigen (HBsAg) were more likely to have spontaneously cleared HCV than were those negative for HBsAg (43% vs. 21%; aOR, 2.91 [95% CI, 1.94-4.38]). Of patients with HCV viremia, 786 (53%) carried HCV genotype 1, and 53 (4%), 440 (29%), and 217 (15%) carried HCV genotype 2, 3, and 4, respectively. A greater HCV RNA level was associated with a greater chance of being infected with HCV genotype 1 (aOR, 1.60 per 1 log higher [95% CI, 1.36-1.88]). CONCLUSIONS: More than three-quarters of the HIV- and HCV Ab-positive patients in EuroSIDA showed active HCV replication. Viremia was more frequent in IDUs and, conversely, was less common in HBsAg-positive patients. Of the patients with HCV viremia analyzed, 53% were found to carry HCV genotype 1, and this genotype was associated with greater serum HCV RNA levels.

The CerdàPlan for the Extension of Barcelona: A Constructivist Analysis of a Town-planning Controversy

Peer-reviewed