Safety and functional outcome of thrombolysis in dissection-related ischemic stroke: a meta-analysis of individual patient data.

Background and Purpose-The safety and efficacy of thrombolysis in cervical artery dissection (CAD) are controversial. The aim of this meta-analysis was to pool all individual patient data and provide a valid estimate of safety and outcome of thrombolysis in CAD.Methods-We performed a systematic literature search on intravenous and intra-arterial thrombolysis in CAD. We calculated the rates of pooled symptomatic intracranial hemorrhage and mortality and indirectly compared them with matched controls from the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register. We applied multivariate regression models to identify predictors of excellent (modified Rankin Scale=0 to 1) and favorable (modified Rankin Scale=0 to 2) outcome.Results-We obtained individual patient data of 180 patients from 14 retrospective series and 22 case reports. Patients were predominantly female (68%), with a mean +/- SD age of 46 +/- 11 years. Most patients presented with severe stroke (median National Institutes of Health Stroke Scale score=16). Treatment was intravenous thrombolysis in 67% and intra-arterial thrombolysis in 33%. Median follow-up was 3 months. The pooled symptomatic intracranial hemorrhage rate was 3.1% (95% CI, 1.3 to 7.2). Overall mortality was 8.1% (95% CI, 4.9 to 13.2), and 41.0% (95% CI, 31.4 to 51.4) had an excellent outcome. Stroke severity was a strong predictor of outcome. Overlapping confidence intervals of end points indicated no relevant differences with matched controls from the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register.Conclusions-Safety and outcome of thrombolysis in patients with CAD-related stroke appear similar to those for stroke from all causes. Based on our findings, thrombolysis should not be withheld in patients with CAD. (Stroke. 2011;42:2515-2520.)

Test result-based sampling: an efficient design for estimating the accuracy of patient safety indicators.

OBJECTIVE: Accuracy studies of Patient Safety Indicators (PSIs) are critical but limited by the large samples required due to low occurrence of most events. We tested a sampling design based on test results (verification-biased sampling [VBS]) that minimizes the number of subjects to be verified. METHODS: We considered 3 real PSIs, whose rates were calculated using 3 years of discharge data from a university hospital and a hypothetical screen of very rare events. Sample size estimates, based on the expected sensitivity and precision, were compared across 4 study designs: random and VBS, with and without constraints on the size of the population to be screened. RESULTS: Over sensitivities ranging from 0.3 to 0.7 and PSI prevalence levels ranging from 0.02 to 0.2, the optimal VBS strategy makes it possible to reduce sample size by up to 60% in comparison with simple random sampling. For PSI prevalence levels below 1%, the minimal sample size required was still over 5000. CONCLUSIONS: Verification-biased sampling permits substantial savings in the required sample size for PSI validation studies. However, sample sizes still need to be very large for many of the rarer PSIs.

Drivers' Behavior at Railroad Grade Crossings: Before and After Safety Campaign, HR-335, 1992

In April 1991 the Iowa Department of Transportation, the CNW Transportation Company, the SOO Line, and local agencies and business in the Mason City/Clear Lake area initiated an Operation Lifesaver program to attempt to increase public awareness of safety issues and safe behavior at railroad-highway grade crossings. This document reports an initial study of data on traffic characteristics at a selected set of grade crossings in Cerro Gordo County taken before and after the safety program. Twenty-two crossings were studied. The 13 crossings at which collisions were reported for the five years prior to the study were included in the sample of sites. Two field observations were made at each study crossing before the Operation Lifesaver campaign was in full swing, and two observations were made after the conclusion of the main effort of the campaign. The summary of each data set is contained in a companion volume. The research shows that Operation Lifesaver altered drivers' behavior in the following ways: (1) reduced approach speeds and crossing speeds at crossings with low speed limits, (2) reduced the percent of drivers approaching the crossing at speeds in excess of the posted speed limit, and (3) increased alertness of drivers to railroad crossing hazards as evidenced by more drivers looking for a clear track. Thus, Operation Lifesaver enhanced safety in street and highway traffic operations in the vicinity of railroad-highway grade crossings.

Efficacy and Safety of Certolizumab Pegol in an Unselected Crohn's Disease Population: 26 Week Data of the FACTS II Survey.

BACKGROUND: Certolizumab pegol (Cimzia, CZP) was approved for the treatment of Crohn's disease (CD) patients in 2007 in Switzerland as first country worldwide. This prospective phase IV study aimed to evaluate the efficacy and safety of CZP over 26 weeks in a multicenter cohort of practice-based patients. METHODS: Evaluation questionnaires at baseline, week 6 and 26 were completed by gastroenterologists in hospitals and private practices. RESULTS: Sixty patients (38F/22M) were included, 53% had complicated disease (stricturing or penetrating), 45% had undergone prior CD related surgery. All patients had prior exposure to systemic steroids, 96% to immunomodulators, 73% to infliximab, and 43% to adalimumab. A significant decrease of Harvey Bradshaw Index (HBI) was observed under CZP therapy (12.24.9 at week 0 vs 6.34.7 at week 6 and 6.75.3 at week 26, both P <0.001). Response and remission rates were 70% and 40% (week 6) and 67% and 36% respectively (week 26). The complete perianal fistula closure rate was 36% at week 6 and 55% at week 26. The frequency of adverse drug reactions attributed to CZP was 5%. CZP was continued in 88% of patients beyond week 6 and in 67% beyond week 26. CONCLUSIONS: In a population of CD patients with predominantly complicated disease behaviour, CZP proved to be effective in induction and maintenance of response and remission. This series provides the first evidence of CZP's effectiveness in perianal fistulizing CD in clinical practice.

The future of patient safety: Surgical trainees accept virtual reality as a new training tool.

BACKGROUND: The use of virtual reality (VR) has gained increasing interest to acquire laparoscopic skills outside the operating theatre and thus increasing patients' safety. The aim of this study was to evaluate trainees' acceptance of VR for assessment and training during a skills course and at their institution. METHODS: All 735 surgical trainees of the International Gastrointestinal Surgery Workshop 2006-2008, held in Davos, Switzerland, were given a minimum of 45 minutes for VR training during the course. Participants' opinion on VR was analyzed with a standardized questionnaire. RESULTS: Fivehundred-twenty-seven participants (72%) from 28 countries attended the VR sessions and answered the questionnaires. The possibility of using VR at the course was estimated as excellent or good in 68%, useful in 21%, reasonable in 9% and unsuitable or useless in 2%. If such VR simulators were available at their institution, most course participants would train at least one hour per week (46%), two or more hours (42%) and only 12% wouldn't use VR. Similarly, 63% of the participants would accept to operate on patients only after VR training and 55% to have VR as part of their assessment. CONCLUSION: Residents accept and appreciate VR simulation for surgical assessment and training. The majority of the trainees are motivated to regularly spend time for VR training if accessible.

Iowa Department of Public Safety Annual Report, FY2013

The Iowa Department of Public Safety (DPS) has a history of dedication and service to the citizens of Iowa and those who visit our state. Since it was first established in 1939, DPS has been the chief law enforcement agency in the State of Iowa. DPS is headquartered in Des Moines, Iowa in the Wallace State Office Building on the Capitol Complex, along with a statewide presence.

Iowa Department of Public Safety Annual Report, FY2012

The Iowa Department of Public Safety (DPS) has a history of dedication and service to the citizens of Iowa and those who visit our state. Since it was first established in 1939, DPS has been the chief law enforcement agency in the State of Iowa. DPS is headquartered in Des Moines, Iowa in the Wallace State Office Building on the Capitol Complex, along with a statewide presence.

Winter Driving A Guide for Your Safety, January 17, 2012

The leading cause of death during winter storms is transportation accidents. Preparing your vehicle for the winter season and knowing how to react if stranded or lost on the road are the keys to safe winter driving.

Winter Weather A guide for Your Safety, January 17, 2012

A major winter storm can be lethal. Preparing for cold weather conditions and responding to them effectively can reduce the dangers caused by winter storms.

Iowa School Safety Guide, April 6, 2012

This document was developed for the schools of Iowa to use as a template to enhance current school safety programs; the creation of this document was a partnered effort at the state level between the aforementioned agencies. The purpose of this document is to give school districts and individual schools a planning resource to use when creating their school safety plans. Ultimately, schools can decide how much of this document they would like to incorporate into their current plan. The original document was created by the Minnesota Department of Homeland Security, and its use was granted to Iowa Homeland Security in 2011. Iowa pulled together a panel of experts to make this document specific to Iowa’s schools, and laws. It’s important to note the partnership created by this document is intended to continue through information sharing in relation to critical assets, infrastructure protection, and school safety. Iowa Homeland Security is a representative in the Iowa Department of Public Safety, Division of Intelligence Fusion Center. This partnership allows for streamlined information sharing to the critical infrastructure owner/operators across the state. The current plan for information sharing is through the Iowa Homeland Security and Emergency Management, Threat information and Infrastructure Protection Program (TIIPP) to the Iowa Department of Education for processing and dissemination statewide. Depending on the type of information being released it could be specific to a school, district or the education sector statewide.

Audit report on the Iowa Department of Public Safety for the year ended June 30, 2013

Audit report on the Iowa Department of Public Safety for the year ended June 30, 2013

The Glass Floor.

A photographic and video record of the project to recreate and reconstruct the glass floor for the opening between the ground and first floors in the rotunda of the Iowa State Capitol. The original glass floor was removed in the early 20th century, but the decision was made to put a new one in to help improve the acoustics and air flow in the building.

Comment on ‘‘Relaxation Kinetics of Nanoscale Indents in a Polymer Glass’’

A Comment on the Letter by A. Knoll, D. Wiesmann, B. Gotsmann, and U. Duerig, published in Physical Review Letter, 2009, vol. 102, p.117801