Delaware County Solid Waste Disposal Commission, Independent Auditor's Reports, Financial Statement and Required Supplementary Information, Schedule of Findings, June 30, 2006

Other Audit Reports - 28E Organizations

Delaware County Solid Waste Disposal Commission, Independent Auditor's Reports, Financial Statement and Required Supplementary Information, Schedule of Findings, June 30, 2004

Other Audit Reports - 28E Organizations

IOWATER Program: Summary of Recent Reports

Summary of water quality data collected by volunteers as part of the IOWATER program.

Application of ultrasound in bone surgery: two case reports

The present study describes some of the applications of ultrasound in bone surgery, based on the presentation of two clinical cases. The Piezosurgery® ultrasound device was used (Tecnología Mectron Medical, Carasco, Italy). In one case the instrument was used to harvest a chin bone graft for placement in a bone defect at level 1.2, while in the other case a bony window osteotomy was made in the external wall of the maxillary sinus, in the context of a sinus membrane lift procedure. The Piezosurgery® device produces specific ultrasound frequency modulation (25-29 kHz), and has been designed to secure increased precision in application to bone surgery. This instrument produces selective sectioning of the mineralized bone structures, and causes less intra- and postoperative bleeding. One of the advantages of the Piezosurgery® device is that it can be used for maxillary sinus lift procedures in dental implant placement. In this context it considerably lessens the risk of sinus mucosa laceration by preparing the bony window in the external wall of the upper maxilla, and can be used to complete the lifting maneuver. The use of ultrasound in application to hard tissues can be regarded as a slow technique compared with the conventional rotary instruments, since it requires special surgical skill and involves a certain learning curve.

Air Formed Arch Culvert Construction: Crawford County, Construction Reports, HR-314, 1991

Iowa's secondary roads contain nearly 15,000 bridges which are less than 40 feet (12 m) in length. Many of these bridges were built several decades ago and need to be replaced. Box culvert construction has proven to be an adequate bridge replacement technique. Recently a new bridge replacement alternative, called the Air-0-Form method, has emerged which has several potential advantages over box culvert construction. This new technique uses inflated balloons as the interior form in the construction of an arch culvert. The objective of research project HR-314 was to construct an air formed arch culvert to determine the applicability of the Air-O-Form technique as a county bridge replacement alternative.

Do Objective Measures of Blood Alcohol Concentrations Make More Sense than Self-reports in Emergency Department Studies?

Purpose: Concerns about self-reports have led to calls for objective measures of blood alcohol concentration (BAC). The present study compared objective measures with self-reports. Methods: BAC from breath or blood samples were obtained from 272 randomly sampled injured patients who were admitted to a Swiss emergency department (ED). Self-reports were compared a) between those providing and refusing a BAC test, and b) to estimated peak BAC (EPBAC) values based on BACs using the Widmark formula. Results: Those providing BACs were significantly (P < 0.05) younger, more often male, and less often reported alcohol consumption before injury, but consumed higher quantities when drinking. Eighty-eight percent of those with BAC measures gave consistent reports (positive or negative). Significantly more patients reported consumption with negative BAC measures (N = 29) than vice versa (N = 3). Duration of consumption and times between injury and BAC measurement predicted EPBAC better than did the objective BAC measure. Conclusions: There is little evidence that patients who provide objective BAC measures deliberately conceal consumption. ED studies must rely on self-reports, eg, take the time period between injury and ED admission into account. Clearly, objective measures are of clinical relevance, eg, to provide optimal treatment in the ED. However, they may be less relevant to establishing effects in an epidemiologic sense, such as estimating risk relationships. In this respect, efforts to increase the validity and reliability of self-reports should be preferred over the collection of additional objective measures.

Prevalence of substance use in a Swiss psychiatric hospital: interview reports and urine screening.

BACKGROUND: Co-morbid substance misuse is common in psychiatric disorders, has potentially severe adverse consequences and may be frequently undetected. AIMS: To measure the prevalence of substance use among patients admitted to a Swiss psychiatric hospital and to examine the potential utility of routine urine drug screening in this setting. METHOD: 266 inpatients were included. 238 patients completed the interview and 240 underwent a urine drug screening. RESULTS: Lifetime prevalence of substance use among psychiatric patients was very high for alcohol (98%; 95% CI: 96-100), benzodiazepines (86%; 95% CI: 82-91) and cannabis (53%; 95% CI: 47-60), but also for "hard drugs" like cocaine (25% ; 95% CI: 19-30) or opiates (20%; 95% CI: 15-25). Regular current use of alcohol (32%; 95% CI: 26-38) or cannabis (17%; 95% CI: 12-22) was the most frequent. Substance use was associated with male sex, younger age, unmarried status and nicotine smoking. Urine screening confirms reports from patients on recent use, and remained positive for cannabis during hospitalisation, but not for cocaine nor for opiates. CONCLUSION: Substance use is frequent among psychiatric patients. Systematic interviewing of patients about their substance use remains essential, and is usually confirmed by urine screening. Urine screening can be useful to provide specific answers about recent use.

La Relevancia de las revistas de geografía física a partir de su repersentación en el Journal Citation Reports del ISI

Se han analizado las revistas internacionales de geografía física para el periodo 1989-2002, utilizando los datos publicados en el Journal Citation Reports (JCR) editado por Thomson Scientific (anteriormente ISI). El JCR clasifica las revistas en categorías, la disciplina de la geografía tiene una propia. Se ha realizado el estudio de la evolución de las revistas incluidas en esta categoría, la tipología de revistas que se reflejan en ella así como la evolución de las que disponen de un factor de impacto más elevado. Este análisis ha permitido ver cuales han sido las publicaciones más importantes durante el periodo estudiado así como realizar una prognosis de la evolución de las revistas contempladas en esta categoría. Los ámbitos temáticos que más revistas aportan son los sistemas de información geográfica y las regiones polares. Las publicaciones sobre biogeografía ocupan un lugar destacado en buena parte de los años estudiados. El valor del factor de impacto de la revista más importante para cada año ha mostrado un incremento significativo, pasando de valores inferiores a uno a finales de los años ochenta, a casi tres en 2002. Esto de debe en parte a las revistas del ámbito del Cuaternario, de incorporación reciente en la categoría de la geografía, las cuales tienen un índice elevado que ha hecho aumentar el factor de impacto de las revistas de cabecera de la categoría

Evaluation du risque de récidive dans les expertises pénales: quels outils? Quets indicateurs? Quelles pratiques [Risk assessment in forensic psychiatric reports: what kind assessment instrument? What indicator? What practical?].

Here we present results of studies conducted by the Research Unit of Legal Psychiatry and Psychology of Lausanne about risk assessment and protective factors in the evaluation of violence recidivism. It aims to help experts in considering the relevance and use of tools at their disposal. Particular attention is given to the significance of protective factors and impulsive dimensions, as to the inter-raters process that leads to the final deliberations.

Boosting Future Prospects or Softening Promises of Success? The Use of Emphatics and Hedging in the Letter to Shareholders Sections of Annual Reports

Tämä pro gradu -tutkielma käsittelee yritysten vuosikertomusten Toimitusjohtajan katsaus -osioissa esiintyvää metatekstiä. Erityisenä tutkimuskohteena ovat yrityksen tulevaisuutta käsittelevät lauseet ja niissä käytetty interpersonaalinen metateksti, jonka avulla kirjoittaja pyrkii joko vahvistamaan (emphatics-keinoin) tai heikentämään (hedging-keinoin) ilmaisujensa vahvuutta ja lukijalle niiden kautta välittyvää kuvaa viestin varmuudesta ja vakuuttavuudesta. Sijoittajille suunnattu Toimitusjohtajan katsaus käsittelee yleensä yrityksen edellisen vuoden tulosta, taloudellista asemaa sekä tulevaisuudennäkymiä. Tutkimuksen tarkoituksena oli selvittää, vaikuttaako yrityksen taloudellinen menestys vuosikertomuksen tässä osiossa käytetyn metatekstin määrään ja laatuun. Tutkimuksen teoriaosuudessa käsitellään ensiksi lyhyesti vuosikertomuksia ja niiden parissa tehtyä aiempaa kielitieteellistä tutkimusta, minkä jälkeen perehdytään tarkemmin metatekstin sekä hedging- ja emphatics-keinojen määrittelyyn. Näissä osioissa apuna toimivat muunmuassa Hylandin (1998) ja Cromptonin (1997) tutkimukset. Tutkimusaineistossa esiintyvien metatekstilajien määrittelyssä ja tunnistamisessa käytettiin apuna pääosin Crismore & Farnsworthin (1990) ja Grabe & Kaplanin (1997) tutkimuksia. Tutkimuksen aineistona oli yhteensä 23 yhdentoista amerikkalaisen yrityksen vuosikertomusta. Ne käsittivät esimerkkejä kunkin yhtiön talouden kannalta sekä erityisen hyviltä että huonoilta vuosilta. Aineistosta löydetty interpersonaalinen metateksti luokiteltiin viiteen eri ryhmään: modaaliverbit, hedging-verbit, muut hedging-keinot, emphatics-keinot ja evaluatives-keinot (eli kirjoittajan tekstistään tekemät subjektiiviset huomiot ja arviot). Tulokset osoittivat, että metatekstin käytössä ilmeni melkoista vaihtelua yksittäisten yritysten ja niiden hyvien ja huonojen vuosien välillä. Nämä eroavuudet eivät kuitenkaan vaikuttaneet merkittävästi koko aineiston kattaviin keskivertolukuihin, joiden avulla pyrittiin selvittämään hyvien ja huonojen vuosien välisiä yleisiä eroja. Tutkimuksen perusteella voidaan todeta, että Toimitusjohtajan katsaus –osioiden viittaukset yhtiön tulevaisuuteen heijastavat tavallisesti kirjoittajan varmuutta yrityksen menestyksekkäästä tulevaisuudesta riippumatta siitä, minkälainen vuosikertomuksessa käsitelty vuosi on ollut yhtiölle taloudellisesti. Yleisesti ottaen yhtiön taloudellisen tilan ei siis havaittu vaikuttavan Toimitusjohtajan katsauksessa käytetyn metadiskurssin määrään tai laatuun.

Intoxication alcoolique aux urgences : dilemmes de prise en charge. Deux situations cliniques fréquentes. [The dilemma of defining "adequate" ED care for acute alcohol intoxication. About two case reports]

L'intoxication éthylique aiguë (IEA) est un motif de recours fréquent en médecine d'urgence. Bien qu'évoluant de manière spontanément favorable dans la majorité des cas, un certain nombre de complications sont susceptibles de survenir dans ce contexte, entrainant des répercussions significatives sur le pronostic des patients. Or, les altérations neurocomportementales accompagnant classiquement ce type d'intoxication mettent régulièrement les cliniciens face à des dilemmes de prise en charge complexes à résoudre. D'autre part, si les propriétés de l'éthanol peuvent atténuer l'expression clinique de certaines pathologies, un certain nombre d'affection de nature métabolique ou neurologique sont susceptibles d'être interprétées à tort comme des IEA. La littérature médicale ne fournissant que peu d'outils d'aide à la décision dans ce domaine, il est souvent difficile de trouver un compromis acceptable entre recours excessif aux examens complémentaires et banalisation face aux patients alcoolisés. A partir de situations cliniques, le présent article propose une approche pragmatique de deux problématiques régulièrement associées à une IEA et sources d'erreur diagnostique, le traumatisme crânien et l'état d'agitation. Ainsi, une meilleure définition des conditions de recours au scanner cérébral en cas de traumatisme crânien et l'adoption d'un protocole de sédation précoce dans l'ivresse excito-motrice doivent permettre de contourner en partie les difficultés soulevées par ces patients.

An evaluation of the Swiss staging model for hypothermia using case reports from the literature.

BACKGROUND: Core body temperature is used to stage and guide the management of hypothermic patients, however obtaining accurate measurements of core temperature is challenging, especially in the pre-hospital context. The Swiss staging model for hypothermia uses clinical indicators to stage hypothermia. The proposed temperature range for clinical stage 1 is <35-32 °C (95-90 °F), for stage 2, <32-28 °C (<90-82 °F) for stage 3, <28-24 °C (<82-75 °F), and for stage 4 below 24 °C (75 °F). However, the evidence relating these temperature ranges to the clinical stages needs to be strengthened. METHODS: Medline was used to retrieve data on as many cases of accidental hypothermia (core body temperature <35 °C (95 °F)) as possible. Cases of therapeutic or neonatal hypothermia and those with confounders or insufficient data were excluded. To evaluate the Swiss staging model for hypothermia, we estimated the percentage of those patients who were correctly classified and compared the theoretical with the observed ranges of temperatures for each clinical stage. The number of rescue collapses was also recorded. RESULTS: We analysed 183 cases; the median temperature for the sample was 25.2 °C (IQR 22-28). 95 of the 183 patients (51.9 %; 95 % CI = 44.7 %-59.2 %) were correctly classified, while the temperature was overestimated in 36 patients (19.7 %; 95 % CI = 13.9 %-25.4 %). We observed important overlaps among the four stage groups with respect to core temperature, the lowest observed temperature being 28.1 °C for Stage 1, 22 °C for Stage 2, 19.3 °C for Stage 3, and 13.7 °C for stage 4. CONCLUSION: Predicting core body temperature using clinical indicators is a difficult task. Despite the inherent limitations of our study, it increases the strength of the evidence linking the clinical hypothermia stage to core temperature. Decreasing the thresholds of temperatures distinguishing the different stages would allow a reduction in the number of cases where body temperature is overestimated, avoiding some potentially negative consequences for the management of hypothermic patients.