Letter health consultation : Northwest States Portland Cement Company site, site, Mason City, Iowa EPA facility ID: IAD98053431 (2008)

This letter has been prepared as a consultation to EPA regarding the third five year review of the Northwestern States Portland Cement Company Site, located North of Mason City, Iowa in Cerro Gordo County to provide an evaluation of the public health status of the site.

Health consultation : Iowa City former manufactured gas plant site, 505 Burlington Street, Iowa City, Johnson County, Iowa EPA facility ID: IAD984591172 (2006)

The United States Environmental Protection Agency (EPA) has requested the Iowa Department of Public Health (IDPH) Hazardous Waste Site Health Assessment Program to evaluate the health impacts of the proposed remedial strategy to be implemented at the Iowa City Former Manufactured Gas Plant Site (FMGP). The proposed remedial strategy to be implemented incorporates the following: 1) access restrictions through the continued operation of the Iowa-Illinois Manor and restriction on any future water well installation through continued implementation of a local environmental covenant; 2) previous site decommissioning activities that have restricted access to site contaminants; and 3) continued monitoring of the groundwater to ensure that contaminant levels in groundwater remain the same or are declining in concentration. This health consultation addresses potential health risks to people from exposure to the soil and vapors within the property. The information in this health consultation was current at the time of writing. Data that emerges later could alter this document’s conclusions and recommendations.

Health consultation : Red Oak Landfill, Red Oak, Montgomery County, Iowa EPA facility ID: IAD980632509 (2005)

Landfill site from the National Priorities List (NPL). The EPA is inviting public comment on the proposed de-listing of the site from the NPL. The Iowa Department of Public Health in cooperation with the Agency for Toxic Substances and Disease Registry (ATSDR) prepared this health consultation to review the current status of the Red Oak Landfill site and to provide an evaluation of any public health consequences of de-listing the site. The information in this health consultation was current at the time of writing. Data that emerges later could alter this document’s conclusions and recommendations.

Rationale and design of a randomized, double-blind, parallel-group study of terutroban 30 mg/day versus aspirin 100 mg/day in stroke patients: the prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) study.

BACKGROUND: Ischemic stroke is the leading cause of mortality worldwide and a major contributor to neurological disability and dementia. Terutroban is a specific TP receptor antagonist with antithrombotic, antivasoconstrictive, and antiatherosclerotic properties, which may be of interest for the secondary prevention of ischemic stroke. This article describes the rationale and design of the Prevention of cerebrovascular and cardiovascular Events of ischemic origin with teRutroban in patients with a history oF ischemic strOke or tRansient ischeMic Attack (PERFORM) Study, which aims to demonstrate the superiority of the efficacy of terutroban versus aspirin in secondary prevention of cerebrovascular and cardiovascular events. METHODS AND RESULTS: The PERFORM Study is a multicenter, randomized, double-blind, parallel-group study being carried out in 802 centers in 46 countries. The study population includes patients aged > or =55 years, having suffered an ischemic stroke (< or =3 months) or a transient ischemic attack (< or =8 days). Participants are randomly allocated to terutroban (30 mg/day) or aspirin (100 mg/day). The primary efficacy endpoint is a composite of ischemic stroke (fatal or nonfatal), myocardial infarction (fatal or nonfatal), or other vascular death (excluding hemorrhagic death of any origin). Safety is being evaluated by assessing hemorrhagic events. Follow-up is expected to last for 2-4 years. Assuming a relative risk reduction of 13%, the expected number of primary events is 2,340. To obtain statistical power of 90%, this requires inclusion of at least 18,000 patients in this event-driven trial. The first patient was randomized in February 2006. CONCLUSIONS: The PERFORM Study will explore the benefits and safety of terutroban in secondary cardiovascular prevention after a cerebral ischemic event.

Audit report on the Peace Officers' Retirement, Accident and Disability System for the year ended June 30, 2015

Audit report on the Peace Officers' Retirement, Accident and Disability System for the year ended June 30, 2015

Report on the Peace Officers’ Retirement, Accident and Disability System, Schedule of Employer Pension Amounts required to implement Governmental Accounting Standards Board (GASB) Statement No. 68, Accounting and Financial Reporting for Pensions for the year ended June 30, 2015

Report on the Peace Officers’ Retirement, Accident and Disability System, Schedule of Employer Pension Amounts required to implement Governmental Accounting Standards Board (GASB) Statement No. 68, Accounting and Financial Reporting for Pensions for the year ended June 30, 2015

Retrospektive Analyse der Mixantron-Behandlung bei Multipler Sklerose von Juli 2000 bis Juni 2007

Résumé :Introduction : La mitoxantrone est un anthracénédione cytostatique aux ef¬fets immunosuppresseurs et -modulateurs qui est administré entre autre dans les évolutions graves de la sclérose en plaques (SEP). Peu d'études concernant l'efficacité et la tolérance de la mitoxantrone ont été publiées. Un travail de re¬cherche statistique s'imposait en raison du nombre de patients souffrant de SEP traités par ce médicament dans le service de neurologie de l'hôpital cantonal d'Aarau.Méthode : Au total, 66 patients souffrant de SEP ont été traités par la mi¬toxantrone dans la période 07/2000-06/2007. 48 d'entre eux avaient reçu préa¬lablement une autre substance modifiant l'évolution de la maladie (« prétrai¬tement » : interféron bêta-la/b, glatirameracétate, azathioprine). Dans cette étude rétrospective, nous avons comparé l'effet de la mitoxantrone par rapport au prétraitement mentionné ci-dessus. Les paramètres appliqués concernaient l'évolution de l'expanded disability status scale (EDSS) et le nombre annuel de poussées pendant la durée du traitement. Une influence du type de SEP, de l'âge au début du traitement par la mitoxantrone, du sexe, de la durée de la théra¬pie et de la maladie ainsi que de la dose cumulative de la mitoxantrone a été recherchée. Nous avons également discuté des éventuels effets indésirables surve¬nus. Nous n'avons pas différencié les substances du prétraitement, étant donné qu'elles avaient été appliquées dans des combinaisons multiples. L'évaluation sta¬tistique a été effectuée en respectant les indications du test de Mann-Whitney ainsi que du Wilcoxon signed-rank test.Résultats : En moyenne, l'EDSS s'est stabilisée (-0,05/année chez tous les 66 patients) tandis que la maladie avait progressé de 0,32/année sous le pré¬traitement (la différence est significative avec p=0,0004 au Wilcoxon signed- rank test bilatéral). Sous le prétraitement, les patients avaient subi en moyenne 1,72 poussées par année, sous la mitoxantrone 0,26 (différence significative avec p<0,0001). La thérapie a dû être arrêtée à cause d'effets indésirables chez quatre patients sous la mitoxantrone (deux avec une granulocytopénie, deux avec une diminution de la fraction d'éjection cardiaque).Discussion : La mitoxantrone s'est avéré une substance particulièrement ef¬ficace même dans les situations dans lesquelles le décours de la maladie n'a pas pu être influencé par d'autres médicaments. Ses effets indésirables doivent être pondérés par rapport à la progression de la maladie et aux effets indési¬rables des autres substances. Les schémas d'application varient beaucoup dans la littérature et doivent être mieux définis.Zusammenfassung :Einleitung: Mitoxantron ist ein zytostatisches Anthracenedion mit immunsup- pressiven und -modulatorischen Eigenschaften, das unter anderem bei schwe¬ren Verläufen der Multiplen Sklerose eingesetzt wird. Bisher befassten sich nur wenige randomisierte und plazebokontrollierte Studien mit Wirksamkeit und Tolerabilität des Medikamentes.Methoden: 66 MS-Patienten der neurologischen Klinik des Kantonsspitals Aar- au wurden zwischen Juli 2000 und Juni 2007 mit Mitoxantron behandelt. 48 davon erhielten zuvor eine MS-spezifische Behandlung mit Interferon ß-1 a oder b, Glatirameracetat oder Azathioprin. Anhand der Veränderung der Expanded Disability Status Scale (EDSS) und der jährlichen Schubrate und mit Hilfe von MRI-Aufnahmen zeichneten wir retrospektiv die Wirksamkeit der Behandlung nach und stellten sie in Beziehung zu einer eventuell erfolgten Vorbehandlung. Des weiteren wurde die Effektivität in Verhältnis zu den Faktoren Verlaufsform, Alter bei Behandlungsbeginn, Behandlungszeit sowie weiteren Parametern ge¬bracht. Wir verglichen die Wirkung von Mitoxantron bei den noch laufenden Behandlungen mit der bei den bereits abgeschlossenen und wir diskutierten die Veränderung von MRI-Aufnahmen des ZNS unter der Therapie mit Mitoxan¬tron. Nebenwirkungen wurden erwähnt.Resultate: Im Durchschnitt wurde der EDSS-Wert stabilisiert (-0, 05/Jahr bei allen 66 Patienten), während die Krankheit unter der verlaufsmodifizierenden Vorbehandlung um durchschnittlich 0,32/Jahr fortschritt (Unterschied signifi¬kant mit p=0,0004 im zweiseitigen Wilcoxon signed-rank test). Die Schubrate betrug 0,26 unter Mitoxantron gegenüber 1,72/Jahr unter Vorbehandlung (Un¬terschied signifikant mit p<0,0001). Bei vier Patienten musste die Therapie auf¬grund von Nebenwirkungen abgebrochen werden (zweimal Granulozytopenie, zweimal verminderte kardiale Auswurffraktion).Diskussion: Mitoxantron ist offensichtlich selbst dann eine äusserst effektive verlaufsmodifizierende Substanz, wenn die Krankheit durch andere Medikamen¬te nicht zu beeinflussen ist. Die Risiken des Medikamentes müssen gegen das Krankheitsfortschreiten und die Nachteile anderer verlaufsmodifizierender Sub¬stanzen abgewogen werden. Die Anwendungsalgorithmen für Mitoxantron vari¬ieren in der Literatur sehr und müssen besser definiert werden.

Life events in conversion disorder: Role of timing and nature of events

Aims: To compare the frequency of life events in the year preceding illness onset in a series of Conversion Disorder (CD) patients, with those of a matched control group and to characterize the nature of those events in terms of "escape" potential. Traditional models of CD hypothesise that relevant stressful experiences are "converted" into physical symptoms to relieve psychological pressure, and that the resultant disability allows "escape" from the stressor, providing some advantage to the individual. Methods: The Life Events and Difficulties Schedule (LEDS) is a validated semi-structured interview designed to minimise recall and interviewer bias through rigorous assessment and independent rating of events. An additional "escape" rating was developed. Results: In the year preceding onset in 25 CD patients (mean age 38.9 years ± 8) and a similar matched period in 13 controls (mean age 36.2 years ± 10), no significant difference was found in the proportion of subjects having ≥ 1 severe event (CD 64%, controls 38%; p=0.2). In the last month preceding onset, a higher number of patients experienced ≥1 severe events than controls (52% vs 15%, odds ratio 5.95 (CI: 1.09-32.57)). Patients were twice as much more likely to have a severe escape events than controls, in the month preceding onset (44% vs 7%, odds ratio 9.43 (CI: 1.06-84.04). Conclusion: Preliminary data from this ongoing study suggest that the time frame (preceding month) and the nature ("escape") of the events may play an important role in identifying key events related to CD onset.

Fractures du calcanéum: du traumatisme aux séquelles [Fractures of the calcaneus: the injury and its sequelae]

The calcaneus gives shape to the heel. Its special position places it in direct contact with the floor, upon which rests the weight of the body. It assures the transition between the vertical skeleton and horizontal surface of the foot, thus permitting ambulation. The calcaneus is subjected to high physical stress, yet at the same time its complex articulating surfaces permit fine adaptation to the ground. Fractures of the calcaneus result from a high energy injury, usually a fall from a height. The treatment of such fractures poses difficult problems. The functional sequelae of the injury may be severe, prolonged, and frequently results in a permanent disability. This is due not only to the type of fracture, but the orthopaedic management as well. Careful evaluation of the patient, fracture pattern, soft tissue condition, and treatment modalities is obligatory to achieve the optimal result.

Id Gene regulation and function in the prosensory domains of the chicken inner ear: a link between Bmp Signaling and Atoh1

Bone morphogenetic proteins (Bmps) regulate the expression of the proneural gene Atoh1 and the generation of hair cells in the developing inner ear. The present work explored the role of Inhibitor of Differentiation genes (Id1-3) in this process. The results show that Id genes are expressed in the prosensory domains of the otic vesicle, along with Bmp4 and Bmp7. Those domains exhibit high levels of the phosphorylated form of Bmp-responding R-Smads (P-Smad1,5,8), and of Bmp-dependent Smad transcriptional activity as shown by the BRE-tk-EGFP reporter. Increased Bmp signaling induces the expression of Id1-3 along with the inhibition of Atoh1. Conversely, the Bmp antagonist Noggin or the Bmp-receptor inhibitor Dorsomorphin elicit opposite effects, indicating that Bmp signaling is necessary for Id expression and Atoh1 regulation in the otocyst. The forced expression of Id3 is sufficient to reduce Atoh1 expression and to prevent the expression of hair cell differentiation markers. Together, these results suggest that Ids are part of the machinery that mediates the regulation of hair cell differentiation exerted by Bmps. In agreement with that, during hair cell differentiation Bmp4 expression, P-Smad1,5,8 levels and Id expression are downregulated from hair cells. However, Ids are also downregulated from the supporting cells which contrarily to hair cells exhibit high levels of Bmp4 expression, P-Smad1,5,8, and BRE-tk-EGFP activity, suggesting that in these cells Ids escape from Bmp/Smad signaling. The differential regulation of Ids in time and space may underlie the multiple functions of Bmp signaling during sensory organ development.

Outcome at two years of age in a Swiss national cohort of extremely preterm infants born between 2000 and 2008.

BACKGROUND: While survival rates of extremely preterm infants have improved over the last decades, the incidence of neurodevelopmental disability (ND) in survivors remains high. Representative current data on the severity of disability and of risk factors associated with poor outcome in this growing population are necessary for clinical guidance and parent counselling. METHODS: Prospective longitudinal multicentre cohort study of preterm infants born in Switzerland between 24(0/7) and 27(6/7) weeks gestational age during 2000-2008. Mortality, adverse outcome (death or severe ND) at two years, and predictors for poor outcome were analysed using multilevel multivariate logistic regression. Neurodevelopment was assessed using Bayley Scales of Infant Development II. Cerebral palsy was graded after the Gross Motor Function Classification System. RESULTS: Of 1266 live born infants, 422 (33%) died. Follow-up information was available for 684 (81%) survivors: 440 (64%) showed favourable outcome, 166 (24%) moderate ND, and 78 (11%) severe ND. At birth, lower gestational age, intrauterine growth restriction and absence of antenatal corticosteroids were associated with mortality and adverse outcome (p < 0.001). At 36(0/7) weeks postmenstrual age, bronchopulmonary dysplasia, major brain injury and retinopathy of prematurity were the main predictors for adverse outcome (p < 0.05). Survival without moderate or severe ND increased from 27% to 39% during the observation period (p = 0.02). CONCLUSIONS: In this recent Swiss national cohort study of extremely preterm infants, neonatal mortality was determined by gestational age, birth weight, and antenatal corticosteroids while neurodevelopmental outcome was determined by the major neonatal morbidities. We observed an increase of survival without moderate or severe disability.

Aging and Disability Resource Center and MHDS Commission Home Modification Assistance Program Plan, December 2015

This report was prepared as a directive to Aging and Disability Resource Centers and The Mental Health and Disability Commission to jointly develop a plan for a home modification assistance program to provide grants and individual income tax credits to assist with expenses related to the making or permanent home modifications that permit individual with a disability to remain in the homes.

Managed Care Ombudsman Program

In Iowa, the Managed Care Ombudsman Program was established to advocate for the rights and wishes of IA Health Link members who live or receive care in a health care facility, assisted living program or elder group home, as well as members enrolled in one of the seven home and community-based services (HCBS) waiver programs: AIDS/HIV, Brain Injury, Children’s Mental Health, Elderly, Health and Disability, Intellectual &/or Physical Disability. All services provided by the Managed Care Ombudsman Program are confidential and free of charge.

Iowa Mental Health and Disability Services Commission, January 2016

This Annual Report of the Iowa Mental Health and Disability Services Commission (the Commission) is being submitted pursuant to Iowa Code § 225C.6(1)(h). The report is organized in two sections: (1) an overview of the activities of the Commission during 2015, and (2) recommendations formulated by the Commission for changes in Iowa law.

Letter health consultation : Doty Landfill site, Camanche, Iowa EPA Facility ID: IAD980497556 (2008)

The Doty Landfill encompasses 13 acres of land and is located in the southeastern quarter of Section 29, Township 81 North, Range 6 East, Clinton County, Iowa. The site was used as a landfill for municipal solid waste from 1970 to 1975. In addition, local residents have expressed concern that other chemical-or pesticide waste had been disposed at the site. Previous site investigations had been completed in 1992 and in 2005. In October 2007 water samples from private wells located in the vicinity of the Doty Landfill site were collected and analyzed for dissolved metals. Two of the water samples obtained from drinking water wells contained dissolved arsenic above the US EPA Maximum Contaminant Level (MCL) for arsenic of 10 μg/L (micrograms per liter) or 10 ppb (parts per billion). The water samples in question contained dissolved arsenic at concentrations of 19.3 and 14.9 μg/L or 19.3 and 14.9 ppb.