Targeted Small Business Link, Winter 2011

Targeted small business news from the Iowa Economic Development Authority's Targeted Small Business Program

Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists.

Diagnosis and decisions on life-sustaining treatment (LST) in disorders of consciousness, such as the vegetative state (VS) and the minimally conscious state (MCS), are challenging for neurologists. The locked-in syndrome (LiS) is sometimes confounded with these disorders by less experienced physicians. We aimed to investigate (1) the application of diagnostic knowledge, (2) attitudes concerning limitations of LST, and (3) further challenging aspects in the care of patients. A vignette-based online survey with a randomized presentation of a VS, MCS, or LiS case scenario was conducted among members of the German Society for Neurology. A sample of 503 neurologists participated (response rate 16.4%). An accurate diagnosis was given by 86% of the participants. The LiS case was diagnosed more accurately (94%) than the VS case (79%) and the MCS case (87%, p < 0.001). Limiting LST for the patient was considered by 92, 91, and 84% of the participants who accurately diagnosed the VS, LiS, and MCS case (p = 0.09). Overall, most participants agreed with limiting cardiopulmonary resuscitation; a minority considered limiting artificial nutrition and hydration. Neurologists regarded the estimation of the prognosis and determination of the patients' wishes as most challenging. The majority of German neurologists accurately applied the diagnostic categories VS, MCS, and LiS to case vignettes. Their attitudes were mostly in favor of limiting life-sustaining treatment and slightly differed for MCS as compared to VS and LiS. Attitudes toward LST strongly differed according to circumstances (e.g., patient's will opposed treatment) and treatment measures.

Blood donor motivation: what is ethical? What works?

The retention of previous donors and the recruitment of new donors is a serious challenge for many blood donation services in their effort to prevent blood shortages. More and more services make use of some sort of donation incentives. However, the use of (material) incentives to motivate blood donors is fiercely controversial and there is a longstanding (ethical) debate about whether it should be allowed that donors receive material rewards. Interestingly, this debate is dealt with in almost complete absence of systematic empirical evidence on the effectiveness of material incentives in encouraging people to donate. In this paper, we argue that the discussion on what is ethical in motivating blood donors should be enriched with empirical evidence based on field experiments. We confront the Titmuss controversy with recent results from an experiment administering lottery tickets as a motivation device. Moreover, we take up a neglected phenomenon in the study of blood donors: many non-donors are not principally against donating blood they have just never made up their mind about becoming active blood donors. We propose active decisions as a mechanism to transform latent prosocial preferences into actual prosocial behavior.

Business Disaster Case Management Task Force, November 2010

During the 2010 session, the Iowa Legislature created per House File 2422 a Business Disaster Case Management Task Force. The purpose of the Task Force is to research disaster recovery case management assistance needed for businesses following a major disaster and to recommend steps for providing such assistance following disasters. The Task Force was duly constituted. Its recommendations are contained in this report. The Task Force focused on what the State of Iowa could do for itself without reliance on federal agencies or programs. It concluded that the hallmarks of any business disaster assistance must be speed of delivery and simplicity in execution. In addition, monies used to assist business recovery should be free of as many restraints on use as possible, relying on the affected businesses to judge for themselves how best to deploy capital resources.

Targeted Small Business Link, May 1,2012

Targeted Small Business information from the Iowa Economic Development Authority

Business Plan Chicago to Iowa City Intercity Passenger Rail Route, March 21, 2012

Overview of the Passenger Service Connects Iowa City, Quad Cities and Chicago, 219.5 miles Twice‐daily service each way, 4 hours and 15 minutes travel time 246,800 passengers first year (676 per day) Project construction cost $310 million (80% federal, 14.5% Illinois, 5.4% Iowa) On‐time performance 90% or better (trains arrive within 10 minutes of schedule) Competitive passenger rail service operator selection Iowa’s annual share of operating cost support averages $3 million

Business Plan Chicago to Iowa City Intercity Passenger Rail Route, March 21, 2011

This business plan describes the methods by which the Iowa Department of Transportation (DOT) will partner with Iowa counties and cities to fund Iowa’s share of the operating and maintenance cost for the Chicago- Iowa City passenger-rail service, an average of $3 million per year.

Telling the truth: medical students' progress with an ethical skill.

BACKGROUND: Truth-telling is a complex task requiring multiple skills in communication, understanding, and empathy. Its application in the context of breaking bad news (BBN) is distressing and problematic if conducted with insufficient skills. PURPOSE: We investigated the long-term influence of a simulated patient-based teaching intervention integrating the learning of communication skills within an ethical reflection on students' ethical attitudes towards truth-telling, perceived competence and comfort in BBN. METHODS: We followed two cohorts of medical students from the preclinical third year to their clinical rotations (fifth year). We analysed their ethical attitudes and level of comfort and competence in BBN before, after the intervention, and during clinical rotations. RESULTS: Students' ethical attitudes towards truth-telling remained stable. Students feeling uncomfortable or incompetent improved their level of perceived comfort or competence after the intervention, but those feeling comfortable or competent became more aware of the difficulty of the situation, and consequently decreased their level of comfort and competence. CONCLUSIONS: Confronting students with a realistic situation and integrating the practice of communication skills within an ethical reflection may be effective in maintaining ethical attitudes towards truth-telling, in developing new skills and increasing awareness about the difficulty and challenges of a BBN situation.

Targeted Small Business Link, Fall 2012

Targeted Small Business News from the Iowa Economic Development Authority

Review of targeted small business procurement activities for the year ended June 30, 2012

Review of targeted small business procurement activities for the year ended June 30, 2012

Small Businesses and Disadvantaged Business Enterprises report

Pursuant to H.F. 2460, passed during the 2010 session of the 83rd Iowa General Assembly, attached are recommendations regarding methods to track and assess the participation of small businesses and disadvantaged business enterprises (DBE) in receiving nonfederal highway funding.

Accès des patients agés aux urgences: evolution démographique et perspectives médico-ethiques [Access of elderly patients in the emergency department: demographic evolution and ethical perspectives].

Due to actual demographic evolution, emergency departments have to face a dramatic increase in admissions of elderly people. The peculiar medical and socio-demographic characteristics of these old patients emphasize the need of specific decision processes and resources allocation. An individual-based approach, related to significant ethical values, should allow better diagnostic and therapeutic attitudes. Such a way to admit, evaluate and treat older patients implies an active collaboration with patients and their relatives, but also with all medical interveners, including in particular primary care physicians.

Report on a review of targeted small business procurement activities for the year ended June 30, 2013

Report on a review of targeted small business procurement activities for the year ended June 30, 2013