Agreed-upon procedures report on the City of Urbana, Iowa for the period July 1, 2013 through June 30, 2014

Agreed-upon procedures report on the City of Urbana, Iowa for the period July 1, 2013 through June 30, 2014

Introduction to Homeland Security and Emergency Management for Local Officials, 2012

The purpose of the Introduction to Homeland Security and Emergency Management for Local Officials is to provide you with information regarding this system. Inside, you will learn about local and state emergency management and homeland security; the phases of homeland security and emergency management; hazards that affect the state; comprehensive planning requirements; emergency declarations; available state and federal assistance; and other important topics that will help you become more versed in homeland security and emergency management in Iowa.

Iowa Emergency Response Plan, October, 2010

The State of Iowa has adopted a multi-hazard approach to managing the consequences of emergency/disaster response. Underlying this approach is the principle that a standard set of generic functional capabilities can be employed to effectively address a wide variety of hazardous conditions and categories of incidents, whether these have a known probability of occurring or are totally unforeseen. Therefore, to the greatest extent possible, the activities described and assigned in this plan are organized along functional lines first, rather than by agency, type of hazard, or type of incident. Contained in this section of the Plan, known as the ―Basic Plan,‖ are instructions, policies, and explanatory information related to many or all of the agencies/entities involved in emergency/ disaster response, as well as information about the legal and administrative foundations for the Plan, the state’s characteristics and significant hazards, lines of succession for the state’s chief executive, plan activation requirements, and the structure of the response organization.

2012 Emergency Response Guidebook: A Guidebook for First Responders During the Initial Phase of a Dangerous Goods/ Hazardous Materials Transportation Incident,

A Guidebook for First Responders During the Initial Phase of a Dangerous Goods/Hazardous Materials Transportation Incident.

Are You Prepared? A Guide to Emergency Preparedness, October 24, 2013

Being prepared means making an emergency plan, building an emergency kit and being aware of the hazards that can impact you. Whether you are at home or at work, emergencies like tornadoes, flooding or winter storms can occur quickly and without warning. We can’t prevent emergencies, but we can prepare for them.

Gériatrie aux urgences: une sélection de publications récentes [Elderly patients in the emergency department: a selection of some recent publications].

Geriatric patients presenting to the ED are at high risk of mortality as well as of cognitive or functional decline. Thus, ED is an ideal spot for interventions that can improve their outcome. In this article, we summarize six recent studies, regarding the utilization of prognostic evaluation scores in geriatric patients presenting to the ED, adverse drug reactions, the significance of elevated troponin in patients who have remained on the ground after a fall, the rationale of performing head CT in patients without focal neurologic findings after a fall, the ideal treatment of a proximal femoral fracture and the excessive use of urinary catheters in the ED.

An integer-based score to predict functional outcome in acute ischemic stroke: The ASTRAL score.

OBJECTIVE: To develop and validate a simple, integer-based score to predict functional outcome in acute ischemic stroke (AIS) using variables readily available after emergency room admission. METHODS: Logistic regression was performed in the derivation cohort of previously independent patients with AIS (Acute Stroke Registry and Analysis of Lausanne [ASTRAL]) to identify predictors of unfavorable outcome (3-month modified Rankin Scale score >2). An integer-based point-scoring system for each covariate of the fitted multivariate model was generated by their β-coefficients; the overall score was calculated as the sum of the weighted scores. The model was validated internally using a 2-fold cross-validation technique and externally in 2 independent cohorts (Athens and Vienna Stroke Registries). RESULTS: Age (A), severity of stroke (S) measured by admission NIH Stroke Scale score, stroke onset to admission time (T), range of visual fields (R), acute glucose (A), and level of consciousness (L) were identified as independent predictors of unfavorable outcome in 1,645 patients in ASTRAL. Their β-coefficients were multiplied by 4 and rounded to the closest integer to generate the score. The area under the receiver operating characteristic curve (AUC) of the score in the ASTRAL cohort was 0.850. The score was well calibrated in the derivation (p = 0.43) and validation cohorts (0.22 [Athens, n = 1,659] and 0.49 [Vienna, n = 653]). AUCs were 0.937 (Athens), 0.771 (Vienna), and 0.902 (when pooled). An ASTRAL score of 31 indicates a 50% likelihood of unfavorable outcome. CONCLUSIONS: The ASTRAL score is a simple integer-based score to predict functional outcome using 6 readily available items at hospital admission. It performed well in double external validation and may be a useful tool for clinical practice and stroke research.

Agreed-upon procedures report on the City of Pomeroy, Iowa for the period August 1, 2013 through July 31, 2014

Agreed-upon procedures report on the City of Pomeroy, Iowa for the period August 1, 2013 through July 31, 2014

Utilité de la prophylaxie antibiotique avant un geste dentaire pour tes porteurs de prothèses totales du genou ou de la hanche [Antibiotic prophylaxis before dental procedures in arthroplasty patients]

Antibiotic prophylaxis is commonly prescribed to patients with total arthroplasties before a dental intervention. This attitude is not evidence-based for several reasons: 1) the usual pathogens of prosthetic joint infections are not of oral origin; 2) even if given, systemic antibiotic do not completely suppress the occult bacteraemia occurring during dental intervention and 3) humans may have up to twelve episodes of occult bacteraemia of dental origin per day. Routine antibiotic prophylaxis should be clearly distinguished from the antibiotic treatment required in case of established oral cavity infection. A constant optimal oral and dental hygiene is more important in terms of prevention and should be routinely recommended to every patient carrying a joint arthroplasty.

Agreed-upon procedures report on the City of Vincent, Iowa for the period August 1, 2013 through July 31, 2014

Agreed-upon procedures report on the City of Vincent, Iowa for the period August 1, 2013 through July 31, 2014

Agreed-upon procedures report on the City of Walcott, Iowa for the period July 1, 2013 through June 30, 2014

Agreed-upon procedures report on the City of Walcott, Iowa for the period July 1, 2013 through June 30, 2014

Agreed-upon procedures report on the City of Kimballton, Iowa for the period July 1, 2013 through June 30, 2014

Agreed-upon procedures report on the City of Kimballton, Iowa for the period July 1, 2013 through June 30, 2014

Agreed-upon procedures report on the City of Glidden, Iowa for the period July 1, 2013 through June 30, 2014

Agreed-upon procedures report on the City of Glidden, Iowa for the period July 1, 2013 through June 30, 2014

Diagnosis and management of blunt great vessel trauma.

Traditionally, thoracic aortic rupture, suspected after blunt thoracic trauma, is characterized by a chest radiograph showing a widened mediastinum. The diagnostic machinery consecutively activated still depends heavily on the pressure as additional traumatic lesions. A patient with additional cranio-cerebral trauma would typically undergo contrast-enhanced computed tomography or magnetic resonance imaging of head, chest, and other regions. In a number of patients these analyses would confirm the presence of blood in the mediastinum without formal proof of an aortic disruption. This is because mediastinal hematomas may be caused not only by an aortic rupture, but also by numerous other blood sources including fractures of the spine and other macro- and microvascular lesions providing similar images. Therefore, aortic angiography became our preferred diagnostic tool to identify or rule out acute traumatic lesions of not only the aorta but with great vessels. However recently, a number of traumatic aortic transsections have been identified by transoesophageal echocardiography (TEE). TEE has the additional advantage of being a bed-side procedure providing additional information about cardiac function. The latter analysis allows for identification and quantification of cardiac contusions, post-traumatic myocardial infarctions, and valvar lesions which are of prime importance to develop an adequate surgical strategy and to assess the risk of the numerous emergency procedures required in patients with polytrauma. The standard approach for repair of isthmic aortic rupture is through a lateral thoracotomy. Distal and proximal control of the aorta can be achieved in a substantial number of cases before complete aortic rupture occurs and a higher proportion of direct suture repair can be achieved under such circumstances. Most proximal descending aortic procedures are performed without cardiopulmonary bypass (clamp and go) but paraplegia may occur before, during, or after the procedure. Ascending aortic lesions and disruption of the aortic arch, the supra-aortic vessels, the main pulmonary arteries, the great veins as well as cardiac lesions are best approached through a sternotomy, which may have to be extended. Cardiopulmonary bypass allowing for deep hypothermia and circulatory arrest is often required and carries its own complications. It is not clear whether the increasing proportion of ascending aortic and cardiac lesions which are observed nowadays are due to a change in trauma mechanics (i.e., speed limits, seat belts, air-bags), an improvement of the diagnostic tools or both.

Critical values of nitrogen indices in tomato plants grown in soil and nutrient solution determined by different statistical procedures

The objective of this study was to establish critical values of the N indices, namely soil-plant analysis development (SPAD), petiole sap N-NO3 and organic N in the tomato leaf adjacent to the first cluster (LAC), under soil and nutrient solution conditions, determined by different statistical approaches. Two experiments were conducted in randomized complete block design with four repli-cations. Tomato plants were grown in soil, in 3 L pot, with five N rates (0, 100, 200, 400 and 800 mg kg-1) and in solution at N rates of 0, 4, 8, 12 and 16 mmol L-1. Experiments in nutrient solution and soil were finished at thirty seven and forty two days after transplanting, respectively. At those times, SPAD index and petiole sap N-NO3 were evaluated in the LAC. Then, plants were harvested, separated in leaves and stem, dried at 70ºC, ground and weighted. The organic N was determined in LAC dry matter. Three statistical procedures were used to calculate critical N values. There were accentuated discrepancies for critical values of N indices obtained with plants grown in soil and nutrient solution as well as for different statistical procedures. Critical values of nitrogen indices at all situations are presented.