Biomedical risk assessment as an aid for smoking cessation.

BACKGROUND: A possible strategy for increasing smoking cessation rates could be to provide smokers who have contact with healthcare systems with feedback on the biomedical or potential future effects of smoking, e.g. measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer. OBJECTIVES: To determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. SEARCH METHODS: For the most recent update, we searched the Cochrane Collaboration Tobacco Addiction Group Specialized Register in July 2012 for studies added since the last update in 2009. SELECTION CRITERIA: Inclusion criteria were: a randomized controlled trial design; subjects participating in smoking cessation interventions; interventions based on a biomedical test to increase motivation to quit; control groups receiving all other components of intervention; an outcome of smoking cessation rate at least six months after the start of the intervention. DATA COLLECTION AND ANALYSIS: Two assessors independently conducted data extraction on each paper, with disagreements resolved by consensus. Results were expressed as a relative risk (RR) for smoking cessation with 95% confidence intervals (CI). Where appropriate, a pooled effect was estimated using a Mantel-Haenszel fixed-effect method. MAIN RESULTS: We included 15 trials using a variety of biomedical tests. Two pairs of trials had sufficiently similar recruitment, setting and interventions to calculate a pooled effect; there was no evidence that carbon monoxide (CO) measurement in primary care (RR 1.06, 95% CI 0.85 to 1.32) or spirometry in primary care (RR 1.18, 95% CI 0.77 to 1.81) increased cessation rates. We did not pool the other 11 trials due to the presence of substantial clinical heterogeneity. Of the remaining 11 trials, two trials detected statistically significant benefits: one trial in primary care detected a significant benefit of lung age feedback after spirometry (RR 2.12, 95% CI 1.24 to 3.62) and one trial that used ultrasonography of carotid and femoral arteries and photographs of plaques detected a benefit (RR 2.77, 95% CI 1.04 to 7.41) but enrolled a population of light smokers and was judged to be at unclear risk of bias in two domains. Nine further trials did not detect significant effects. One of these tested CO feedback alone and CO combined with genetic susceptibility as two different interventions; none of the three possible comparisons detected significant effects. One trial used CO measurement, one used ultrasonography of carotid arteries and two tested for genetic markers. The four remaining trials used a combination of CO and spirometry feedback in different settings. AUTHORS' CONCLUSIONS: There is little evidence about the effects of most types of biomedical tests for risk assessment on smoking cessation. Of the fifteen included studies, only two detected a significant effect of the intervention. Spirometry combined with an interpretation of the results in terms of 'lung age' had a significant effect in a single good quality trial but the evidence is not optimal. A trial of carotid plaque screening using ultrasound also detected a significant effect, but a second larger study of a similar feedback mechanism did not detect evidence of an effect. Only two pairs of studies were similar enough in terms of recruitment, setting, and intervention to allow meta-analyses; neither of these found evidence of an effect. Mixed quality evidence does not support the hypothesis that other types of biomedical risk assessment increase smoking cessation in comparison to standard treatment. There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment.

Miguel de Unamuno and Heraclitus: from ‘The Eternal Elegy’ (‘La elegía eterna’) to ‘The Cut Flower’(‘La flor tronchada’)

The aim of this brief article is to demonstrate and analyze the influence of Heraclitus’s thought on some of the poems written by Miguel de Unamuno, in particular ‘La elegía eterna’ and ‘La flor tronchada’. At times –as in ‘La elegía eterna’– Heraclitus merely serves as a sort of a walking stick, an aid to his efforts to poetically reveal his anxieties. On other occasions –as in ‘La flor tronchada’– he genuinely needs Heraclitus’s philosophy to illustrate his view of human life and its relation to God as unending warfare.

Biomedical risk assessment as an aid for smoking cessation.

BACKGROUND: A possible strategy for increasing smoking cessation rates could be to provide smokers who have contact with healthcare systems with feedback on the biomedical or potential future effects of smoking, e.g. measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer. We reviewed systematically data on smoking cessation rates from controlled trials that used biomedical risk assessment and feedback. OBJECTIVES: To determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. SEARCH STRATEGY: We systematically searched he Cochrane Collaboration Tobacco Addiction Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 2004), and EMBASE (1980 to 2004). We combined methodological terms with terms related to smoking cessation counselling and biomedical measurements. SELECTION CRITERIA: Inclusion criteria were: a randomized controlled trial design; subjects participating in smoking cessation interventions; interventions based on a biomedical test to increase motivation to quit; control groups receiving all other components of intervention; an outcome of smoking cessation rate at least six months after the start of the intervention. DATA COLLECTION AND ANALYSIS: Two assessors independently conducted data extraction on each paper, with disagreements resolved by consensus. MAIN RESULTS: From 4049 retrieved references, we selected 170 for full text assessment. We retained eight trials for data extraction and analysis. One of the eight used CO alone and CO + Genetic Susceptibility as two different intervention groups, giving rise to three possible comparisons. Three of the trials isolated the effect of exhaled CO on smoking cessation rates resulting in the following odds ratios (ORs) and 95% confidence intervals (95% CI): 0.73 (0.38 to 1.39), 0.93 (0.62 to 1.41), and 1.18 (0.84 to 1.64). Combining CO measurement with genetic susceptibility gave an OR of 0.58 (0.29 to 1.19). Exhaled CO measurement and spirometry were used together in three trials, resulting in the following ORs (95% CI): 0.6 (0.25 to 1.46), 2.45 (0.73 to 8.25), and 3.50 (0.88 to 13.92). Spirometry results alone were used in one other trial with an OR of 1.21 (0.60 to 2.42).Two trials used other motivational feedback measures, with an OR of 0.80 (0.39 to 1.65) for genetic susceptibility to lung cancer alone, and 3.15 (1.06 to 9.31) for ultrasonography of carotid and femoral arteries performed in light smokers (average 10 to 12 cigarettes a day). AUTHORS' CONCLUSIONS: Due to the scarcity of evidence of sufficient quality, we can make no definitive statements about the effectiveness of biomedical risk assessment as an aid for smoking cessation. Current evidence of lower quality does not however support the hypothesis that biomedical risk assessment increases smoking cessation in comparison with standard treatment. Only two studies were similar enough in term of recruitment, setting, and intervention to allow pooling of data and meta-analysis.

Dedicated to Better and Safer Highways, Iowa State Highway Commission, July 1973

The planning, construction and maintenance of its highways is the state's second highest business, next only to education. Of the nearly 113,090 miles of roads and streets in Iowa, the 10,271 miles in the Interstate and primary system are the direct responsibility of the Highway Commission.From its central headquarters in Ames, the Commission coordinates its statewide activities through facilities located in each of the 99 counties. These include six district offices, 47 resident offices and 165 maintenance garages.

Statewide Transportation Improvement Program 2015-2018: Sorted by MPO and RPA, 2014

Iowa’s Statewide Transportation Improvement Program (STIP) has been developed in conformance with the guidelines prescribed by 23 U.S.C. and 49 U.S.C. The STIP is generated to provide the Federal Highway Administration and Federal Transit Administration a listing of all projects that are candidates for federal aid from the FHWA and FTA for four federal fiscal years (FFY). The 2015-2018 STIP was approved by FHWA and FTA on September 16, 2014. Preceding the listings of federal-aid candidates are general comments concerning Iowa’s public participation process for selection of federal-aid projects and the basis for funding the proposed projects. Documents evidencing the Iowa Department of Transportation’s authority to act concerning matters related to transportation, federal-aid expenditures and approvals of metropolitan planning organizations’ (MPOs), transportation improvements programs (TIPs) have been provided in past STIPs and can be provided again upon request.

Statewide Transportation Improvement Program 2014-2017: Sorted by MPO and RPA, 2013

Iowa’s Statewide Transportation Improvement Program (STIP) has been developed in conformance with the guidelines prescribed by 23 U.S.C. and 49 U.S.C. The STIP is generated to provide the Federal Highway Administration and Federal Transit Administration a listing of all projects that are candidates for federal aid from the FHWA and FTA for four federal fiscal years (FFY). The 2015-2018 STIP was approved by FHWA and FTA on September 16, 2014. Preceding the listings of federal-aid candidates are general comments concerning Iowa’s public participation process for selection of federal-aid projects and the basis for funding the proposed projects. Documents evidencing the Iowa Department of Transportation’s authority to act concerning matters related to transportation, federal-aid expenditures and approvals of metropolitan planning organizations’ (MPOs), transportation improvements programs (TIPs) have been provided in past STIPs and can be provided again upon request.

Statewide Transportation Improvement Program 2013-2016: Sorted by MPO and RPA, 2012

Iowa’s Statewide Transportation Improvement Program (STIP) has been developed in conformance with the guidelines prescribed by 23 U.S.C. and 49 U.S.C. The STIP is generated to provide the Federal Highway Administration and Federal Transit Administration a listing of all projects that are candidates for federal aid from the FHWA and FTA for four federal fiscal years (FFY). Preceding the listings of federal-aid candidates are general comments concerning Iowa’s public participation process for selection of federal-aid projects and the basis for funding the proposed projects. Documents evidencing the Iowa Department of Transportation’s authority to act concerning matters related to transportation, federal-aid expenditures and approvals of metropolitan planning organizations’ (MPOs), transportation improvements programs (TIPs) have been provided in past STIPs and can be provided again upon request.

Issue review : school formula funding -- supplementary weightings.

Supplementary weightings for school districts are estimated to generate approximately 63.9 million dollars in funding in fiscal year 2011. This issue review provides an overview of all supplementary weightings currently available to school districts and examines the total funding amounts from fiscal year 2003 through fiscal year 2011.

Issue review : state funding for libraries.

The state appropriates funds to support library services to Iowans through the State Library, the Library Service Areas, and state aid to local libraries known as Enrich Iowa. As a result of legislation enacted in 2010, the Iowa Library Association, or ILA, convened a committee to make recommendations regarding reorganization of state-funded library operations and services. The committee's recommendations have been approved by the ILA and endorsed by the State Commission of Libraries. The recommendations described involve the reorganization of the State Library and Library Service Areas.

Issue review : school district cash reserve levy.

During the recent economic crisis, school district budgets have been impacted by state school aid funding shortfalls and state aid reductions due to across-the-board general fund reductions in fiscal year 2009 and fiscal year 2010. Additionally, in fiscal year 2011, the state school aid appropriation was capped and was 156.1 million dollars short of fully funding the state portion of the school aid formula. This issue review examines the impact that the reductions in state aid have had on school district cash reserve levies.

Issue review : Instructional support program funding inequities.

School districts may receive funding for the instructional support program subject to school board or voter approval. Program funding is based on a formula that includes a local funding provision, property tax and income surtax and a state aid component. When initially implemented, state aid was distributed through a formula designed to provide property tax equity and equalize the property tax burden between school districts. Since the initial year of the program, the state aid portion has not been fully funded and in fiscal year 2012, no state dollars were appropriated for the program. The result of underfunding the state-aid portion of the program has led to an inequity in the amount of funds school districts receive from the program. In fiscal year 2012, the portion of actual program funding for school districts ranged from a low of 52.6 percent to a high of 92.8 percent. This issue review examines the inequity in more detail.

How Millennials are changing the way of learning: the state of the art of ICT integration in education

Millennials generation is changing the way of learning, prompting educational institutions to attempt to better adapt to young needs by incorporating technologies into education. Based on this premise, we have reviewed the prominent reports of the integration of ICT into education with the aim of evidencing how education is changing, and will change, to meet the needs ofMillennials with ICT support. We conclude that most of the investments have simply resulted in an increase of computers and access to the Internet, with teachers reproducing traditional approaches to education and e-learning being seen as complementary to face-to-face education. While it would seem that the use of ICT is not revolutionizing learning, it is facilitating the personalization, collaboration and ubiquity of learning.

Technology-enhanced education for Millennials: how the Information Society is changing the way of learning

The Information Society has provided the context for the development of a new generation, known as the Millennials, who are characterized by their intensive use of technologies in everyday life. These features are changing the way of learning, prompting educational institutions to attempt to better adapt to youngneeds by incorporating technologies into education. Based on this premise, wehave reviewed the prominent reports of the integration of ICT into education atdifferent levels with the aim of evidencing how education is changing, and willchange, to meet the needs of Millennials with ICT support. The results show thatmost of the investments have simply resulted in an increase of computers andaccess to the Internet, with teachers reproducing traditional approaches to education and e-learning being seen as complementary to face-to-face education.While it would seem that the use of ICT is not revolutionizing learning, it isfacilitating the personalization, collaboration and ubiquity of learning.

Statewide Transportation Improvement Program 2016-2019: Sorted by MPO and RPA, 2015

Iowa’s Statewide Transportation Improvement Program (STIP) has been developed in conformance with the guidelines prescribed by 23 U.S.C. and 49 U.S.C. The STIP is generated to provide the Federal Highway Administration and Federal Transit Administration a listing of all projects that are candidates for federal aid from the FHWA and FTA for the four federal fiscal years (FFY) 2016-2019. The 2016-2019 STIP was approved by FHWA and FTA on September 29, 2015. Preceding the listings of federal-aid candidates are general comments concerning Iowa’s public participation process for selection of federal-aid projects and the basis for funding the proposed projects. Documents evidencing the Iowa Department of Transportation’s authority to act concerning matters related to transportation, federal-aid expenditures, and approvals of metropolitan planning organizations’ (MPOs) transportation improvements programs (TIPs) have been provided in past STIPs and can be provided again upon request.

Implementation of the Federal Highway Administration Final Rule on Work Zone Safety and Mobility, 2007

The Federal Highway Administration published the final rule updating 23 CFR 630 Subpart J in September 2004. The revised rule requires agencies using federal funding to address both safety and mobility in planning and construction of roadway improvements. The Iowa Department of Transportation (Iowa DOT) requested the assistance of the Center for Transportation and Research in developing guidance for a policy and procedures to comply with the final rule. This report describes an in-depth examination of current Iowa DOT project development processes for all types of improvements, including maintenance, as well as a detailed characterization of work zone impact considerations throughout project completion. To comply with both the letter and perceived intent of the final rule on safety and mobility, the report features a suggested work zone policy statement and suggested revisions in the Iowa DOT project development processes, including a definition of the key element: significant projects.