Report on a special investigation of the City of Sloan for the period May 19, 2009 through March 31, 2013

Report on a special investigation of the City of Sloan for the period May 19, 2009 through March 31, 2013

Examination report on the City of Sidney, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Sidney, Iowa for the period July 1, 2012 through June 30, 2013

Reaudit report on the North Central Iowa Regional Solid Waste Agency for the period July 1, 2011 through June 30, 2012

Reaudit report on the North Central Iowa Regional Solid Waste Agency for the period July 1, 2011 through June 30, 2012

Special investigation of the Garner Volunteer Ambulance Service for the period July 1, 2011 through June 30, 2012

Special investigation of the Garner Volunteer Ambulance Service for the period July 1, 2011 through June 30, 2012

Three short perioperative infusions of n-3 PUFAs reduce systemic inflammation induced by cardiopulmonary bypass surgery: a randomized controlled trial.

BACKGROUND: Fish oil (FO) has antiinflammatory effects, which might reduce systemic inflammation induced by a cardiopulmonary bypass (CPB). OBJECTIVE: We tested whether perioperative infusions of FO modify the cell membrane composition, inflammatory responses, and clinical course of patients undergoing elective coronary artery bypass surgery. DESIGN: A prospective randomized controlled trial was conducted in cardiac surgery patients who received 3 infusions of 0.2 g/kg FO emulsion or saline (control) 12 and 2 h before and immediately after surgery. Blood samples (7 time points) and an atrial biopsy (during surgery) were obtained to assess the membrane incorporation of PUFAs. Hemodynamic data, catecholamine requirements, and core temperatures were recorded at 10-min intervals; blood triglycerides, nonesterified fatty acids, glucose, lactate, inflammatory cytokines, and carboxyhemoglobin concentrations were measured at selected time points. RESULTS: Twenty-eight patients, with a mean ± SD age of 65.5 ± 9.9 y, were enrolled with no baseline differences between groups. Significant increases in platelet EPA (+0.86%; P = 0.0001) and DHA (+0.87%; P = 0.019) were observed after FO consumption compared with at baseline. Atrial tissue EPA concentrations were higher after FO than after control treatments (+0.5%; P < 0.0001). FO did not significantly alter core temperature but decreased the postoperative rise in IL-6 (P = 0.018). Plasma triglycerides increased transiently after each FO infusion. Plasma concentrations of glucose, lactate, and blood carboxyhemoglobin were lower in the FO than in the control group on the day after surgery. Arrhythmia incidence was low with no significant difference between groups. No adverse effect of FO was detected. CONCLUSIONS: Perioperative FO infusions significantly increased PUFA concentrations in platelet and atrial tissue membranes within 12 h of the first FO administration and decreased biological and clinical signs of inflammation. These results suggest that perioperative FO may be beneficial in elective cardiac surgery with CPB. This trial was registered at clinicaltrials.gov as NCT00516178.

Report on a special investigation of the City of Riverside for the period July 1, 2006 through December 31, 2012

Report on a special investigation of the City of Riverside for the period July 1, 2006 through December 31, 2012

Examination report on the City of Sully, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Sully, Iowa for the period July 1, 2012 through June 30, 2013

Treatment of ruptured abdominal aortic aneurysm, a permanent challenge or a waste of resources? Prediction of outcome using a multi-organ-dysfunction score.

OBJECTIVES: in a retrospective study, attempts have been made to identify individual organ-dysfunction risk profiles influencing the outcome after surgery for ruptured abdominal aortic aneurysms. METHODS: out of 235 patients undergoing graft replacement for abdominal aortic aneurysms, 57 (53 men, four women, mean age 72 years [s.d. 8.8]) were treated for ruptured aneurysms in a 3-year period. Forty-eight preoperative, 13 intraoperative and 34 postoperative variables were evaluated statistically. A simple multi-organ dysfunction (MOD) score was adopted. RESULTS: the perioperative mortality was 32%. Three patients died intraoperatively, four within 48 h and 11 died later. A significant influence for pre-existing risk factors was identified only for cardiovascular diseases. Multiple linear-regression analysis indicated that a haemoglobin <90 g/l, systolic blood pressure <80 mmHg and ECG signs of ischaemia at admission were highly significant risk factors. The cause of death for patients, who died more than 48 h postoperatively, was mainly MOD. All patients with a MOD score >/=4 died (n=7). These patients required 27% of the intensive-care unit (ICU) days of all patients and 72% of the ICU days of the non-survivors. CONCLUSION: patients with ruptured aortic aneurysms from treatment should not be excluded. However, a physiological scoring system after 48 h appears justifiable in order to decide on the appropriateness of continual ICU support.

Report on a review of the Sixth Judicial District Department of Correctional Services for the period July 1, 2008 through June 30, 2012

Report on a review of the Sixth Judicial District Department of Correctional Services for the period July 1, 2008 through June 30, 2012

Examination report on the City of Emerson, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Emerson, Iowa for the period July 1, 2012 through June 30, 2013

Report on a review of selected general and application controls over the Iowa Department of Transportation’s Vehicle Registration and Title System for the period April 16, 2012 through May 15, 2012

Report on a review of selected general and application controls over the Iowa Department of Transportation’s Vehicle Registration and Title System for the period April 16, 2012 through May 15, 2012

Examination report on the City of Dike, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Dike, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Urbana, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Urbana, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Murray, Iowa for the period July 1, 2012 through June 30, 2013

Examination report on the City of Murray, Iowa for the period July 1, 2012 through June 30, 2013