Clarke Community School District, Independent Auditor's Reports, Basic Financial Statements and Supplementary Information, Schedule of Findings and Questioned Costs, June 30, 2005

Community School District Audit Report

β-Lactam Monotherapy vs β-Lactam-Macrolide Combination Treatment in Moderately Severe Community-Acquired Pneumonia: A Randomized Noninferiority Trial.

IMPORTANCE: The clinical benefit of adding a macrolide to a β-lactam for empirical treatment of moderately severe community-acquired pneumonia remains controversial. OBJECTIVE: To test noninferiority of a β-lactam alone compared with a β-lactam and macrolide combination in moderately severe community-acquired pneumonia. DESIGN, SETTING, AND PARTICIPANTS: Open-label, multicenter, noninferiority, randomized trial conducted from January 13, 2009, through January 31, 2013, in 580 immunocompetent adult patients hospitalized in 6 acute care hospitals in Switzerland for moderately severe community-acquired pneumonia. Follow-up extended to 90 days. Outcome assessors were masked to treatment allocation. INTERVENTIONS: Patients were treated with a β-lactam and a macrolide (combination arm) or with a β-lactam alone (monotherapy arm). Legionella pneumophila infection was systematically searched and treated by addition of a macrolide to the monotherapy arm. MAIN OUTCOMES AND MEASURES: Proportion of patients not reaching clinical stability (heart rate <100/min, systolic blood pressure >90 mm Hg, temperature <38.0°C, respiratory rate <24/min, and oxygen saturation >90% on room air) at day 7. RESULTS: After 7 days of treatment, 120 of 291 patients (41.2%) in the monotherapy arm vs 97 of 289 (33.6%) in the combination arm had not reached clinical stability (7.6% difference, P = .07). The upper limit of the 1-sided 90% CI was 13.0%, exceeding the predefined noninferiority boundary of 8%. Patients infected with atypical pathogens (hazard ratio [HR], 0.33; 95% CI, 0.13-0.85) or with Pneumonia Severity Index (PSI) category IV pneumonia (HR, 0.81; 95% CI, 0.59-1.10) were less likely to reach clinical stability with monotherapy, whereas patients not infected with atypical pathogens (HR, 0.99; 95% CI, 0.80-1.22) or with PSI category I to III pneumonia (HR, 1.06; 95% CI, 0.82-1.36) had equivalent outcomes in the 2 arms. There were more 30-day readmissions in the monotherapy arm (7.9% vs 3.1%, P = .01). Mortality, intensive care unit admission, complications, length of stay, and recurrence of pneumonia within 90 days did not differ between the 2 arms. CONCLUSIONS AND RELEVANCE: We did not find noninferiority of β-lactam monotherapy in patients hospitalized for moderately severe community-acquired pneumonia. Patients infected with atypical pathogens or with PSI category IV pneumonia had delayed clinical stability with monotherapy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00818610.

Human Rights Community Action Performance Report, FY 2004

Agency Performance Report

Human Rights Community Action Performance Report, FY 2005

Agency Performance Report

Community Action In Iowa-Annual Report, 2004

This report details the efforts of the community action network in Iowa.

Community Action In Iowa-Annual Report, 1999

This report details the efforts of the community action network in Iowa.

Community Action In Iowa-Annual Report, 2000

This report details the efforts of the community action network in Iowa.

Community Action In Iowa-Annual Report, 2001

This report details the efforts of the community action network in Iowa.

Community Action In Iowa-Annual Report, 2002

This report details the efforts of the community action network in Iowa.

Community Action In Iowa-Annual Report, 2003

This report details the efforts of the community action network in Iowa.

Perry Community School District, Independent Auditor's Reports, Basic Financial Statements and Supplementary Information, Schedule of Findings and Questioned Costs, June 30, 2005

Community School District Audit Report

Iowa Community Empowerment Newsletter, April 2006, Vol.7, no.2

Monthly newsletter for the Iowa Department of Public Health

Iowa Community Empowerment Newsletter, February 2007, Vol.8, no.1

Monthly newsletter for the Iowa Department of Public Health

Is a Combined School/Public Library Right for Your Community?

This document is intended to assist Iowa communities in making informed decisions on combining school and public library services. It provides decision-makers with a means of assessing the feasibility of establishing a combined library and, if the decision is made to proceed, with a Planning Guide that addresses the many areas of library operations that need to be considered if the combined library is to be successful. Alternatives to combining libraries exist. Contracted services provide one such option. There are many areas where school and public libraries can and should collaborate in order to provide better service to the community. These alternatives are also outlined in this document.

Kirkwood Community College, Independent Auditor's Reports, Basic Financial Statements and Supplementary Information, Schedule of Findings and Questioned Costs, June 30, 2005

Community College Audit Reports