The nine-year sustained cost-containment impact of swiss pilot physicians-pharmacists quality circles.

BACKGROUND: Six pioneer physicians-pharmacists quality circles (PPQCs) located in the Swiss canton of Fribourg (administratively corresponding to a state in the US) were under the responsibility of 6 trained community pharmacists moderating the prescribing process of 24 general practitioners (GPs). PPQCs are based on a multifaceted collaborative process mediated by community pharmacists for improving compliance with clinical guidelines within GPs' prescribing practices. OBJECTIVE: To assess, over a 9-year period (1999-2007), the cost-containment impact of the PPQCs. METHODS: The key elements of PPQCs are a structured continuous quality improvement and education process; local networking; feedback of comparative and detailed data regarding costs, drug choice, and frequency of prescribed drugs; and structured independent literature review for interdisciplinary continuing education. The data are issued from the community pharmacy invoices to the health insurance companies. The study analyzed the cost-containment impact of the PPQCs in comparison with GPs working in similar conditions of care without particular collaboration with pharmacists, the percentage of generic prescriptions for specific cardiovascular drug classes, and the percentage of drug costs or units prescribed for specific cardiovascular drugs. RESULTS: For the 9-year period, there was a 42% decrease in the drug costs in the PPQC group as compared to the control group, representing a $225,000 (USD) savings per GP only in 2007. These results are explained by better compliance with clinical and pharmacovigilance guidelines, larger distribution of generic drugs, a more balanced attitude toward marketing strategies, and interdisciplinary continuing education on the rational use of drugs. CONCLUSIONS: The PPQC work process has yielded sustainable results, such as significant cost savings, higher penetration of generics and reflection on patient safety, and the place of "new" drugs in therapy. The PPQCs may also constitute a solid basis for implementing more comprehensive collaborative programs, such as medication reviews, adherence-enhancing interventions, or disease management approaches.

Demonstration and Field Evaluation of Alternative Portland Cement Concrete Pavement Reinforcement Materials, HR-1069, 2003

Transverse joints are placed in portland cement concrete pavements to control the development of random cracking due to stresses induced by moisture and thermal gradients and restrained slab movement. These joints are strengthened through the use of load transfer devices, typically dowel bars, designed to transfer load across the joint from one pavement slab to the next. Epoxy coated steel bars are the materials of choice at the present time, but have experienced some difficulties with resistance to corrosion from deicing salts. The research project investigated the use of alternative materials, dowel size and spacing to determine the benefits and limitations of each material. In this project two types of fiber composite materials, stainless steel solid dowels and epoxy coated dowels were tested for five years in side by side installation in a portion of U.S. 65 near Des Moines, Iowa, between 1997 and 2002. The work was directed at analyzing the load transfer characteristics of 8-in. vs. 12-in. spacing of the dowels and the alternative dowel materials, fiber composite (1.5- and 1.88-in. diameter) and stainless steel (1.5-in. diameter), compared to typical 1.5-in. diameter epoxy-coated steel dowels placed on 12-in. spacing. Data were collected biannually within each series of joints and variables in terms of load transfer in each lane (outer wheel path), visual distress, joint openings, and faulting in each wheel path. After five years of performance the following observations were made from the data collected. Each of the dowel materials is performing equally in terms of load transfer, joint movement and faulting. Stainless steel dowels are providing load transfer performance equal to or greater than epoxy-coated steel dowels at the end of five years. Fiber reinforced polymer (FRP) dowels of the sizes and materials tested should be spaced no greater than 8 in. apart to achieve comparable performance to epoxy coated dowels. No evidence of deterioration due to road salts was identified on any of the products tested. The relatively high cost of stainless steel solid and FRP dowels was a limitation at the time of this study conclusion. Work is continuing with the subject materials in laboratory studies to determine the proper shape, spacing, chemical composition and testing specification to make the FRP and stainless (clad or solid) dowels a viable alternative joint load transfer material for long lasting portland cement concrete pavements.

A Review of the Frictional Classification of Iowa Aggregates, MLR-81-04, 1981

The Iowa D.O.T. has a classification system designed to rate coarse aggregates as to their skid resistant characteristics. Aggregates have been classified into five functional types, with a Type 1 being the most skid resistant. A complete description of the classification system can be found in the Office of Materials Instructional Memorandum T-203. Due to the variability of ledges within any given quarry the classification of individual ledges becomes necessary. The type of aggregate is then specified for each asphaltic concrete surface course. As various aggregates become used in a.c. paving, there is a continuing process of evaluating the frictional properties of the pavement surface. It is primarily through an effort of this sort that information on aggregate sources and individual ledges becomes more refined. This study is being conducted to provide that needed up-to-date information that can be used to monitor the aggregate classification system.

Performance of Reinforcement Fabric Used Under Asphaltic Concrete Overlays, MLR-83-03, 1983

The 1982 cost of a two-inch asphaltic concrete overlay, with fabric, was an average of 85% of the cost of a three-inch overlay (see attached calculations). A structural number can be assigned to the extra inch of overlay, whereas it is doubtful that any number can be assigned to the fabric. The observations made on the projects in this report leave little reason to be optimistic on the use of fabrics under asphalt overlays. This is especially true of the Floyd, Dallas and Clarke county projects. A great amount of fabric is being used nationwide for this purpose, probably more from sales promotion than from actual documented performance. Full scale field testing is continuing each time a project is let utilizing fabric reinforcement under asphaltic concrete overlays. It has already become apparent that the use of fabrics in AC overlays is not always cost effective.

Low-Cost Rural Surface Alternatives: Demonstration Project, TR-664, 2015

The goals of this project were to implement several stabilization methods for preventing or mitigating freeze-thaw damage to granular surfaced roads and identify the most effective and economical methods for the soil and climate conditions of Iowa. Several methods and technologies identified as potentially suitable for Iowa were selected from an extensive analysis of existing literature provided with Iowa Highway Research Board (IHRB) Project TR-632. Using the selected methods, demonstration sections were constructed in Hamilton County on a heavily traveled two-mile section of granular surfaced road that required frequent maintenance during previous thawing periods. Construction procedures and costs of the demonstration sections were documented, and subsequent maintenance requirements were tabulated through two seasonal freeze-thaw periods. Extensive laboratory and field tests were performed prior to construction, as well as before and after the two seasonal freeze-thaw periods, to monitor the performance of the demonstration sections. A weather station was installed at the project site and temperature sensors were embedded in the subgrade to monitor ground temperatures up to a depth of 5 ft and determine the duration and depths of ground freezing and thawing. An economic analysis was performed using the documented construction and maintenance costs, and the estimated cumulative costs per square yard were projected over a 20-year timeframe to determine break-even periods relative to the cost of continuing current maintenance practices. Overall, the sections with biaxial geogrid or macadam base courses had the best observed freeze-thaw performance in this study. These two stabilization methods have larger initial costs and longer break-even periods than aggregate columns, but counties should also weigh the benefits of improved ride quality and savings that these solutions can provide as excellent foundations for future paving or surface upgrades.

Your Course to College (2015-16)

This comprehensive guide, updated for the 2015-2015 academic year, provides financial aid information, as well as a directory of Iowa colleges and universities to assist students and families with the college selection process.

Iowa Racing & Gaming Commission, 2010 Annual Report

2009 Annual Report on behalf of the Iowa Racing and Gaming Commission (the Commission). The Commission is committed to maintaining a vibrant gaming industry that provides economic growth and development for the State of Iowa while continuing to promote responsible gaming and ensuring continued participation in the "Buy Iowa First" program. Although revenues at the casinos slipped during the year reflecting the general downturn in the economy, the gaming industry once again contributed over $1 billion to the state's economy, including over $300 million in gaming taxes.

School Leader Update, August 2015

Monthly newsletter produced by Iowa Department of Education

School Leader Update, October 2015

Monthly newsletter produced by Iowa Department of Education

Development of pharmaceutical care services in nursing homes: practice and research in a Swiss canton.

OBJECTIVE: The aim of this study was to assess the implementation process and economic impact of a new pharmaceutical care service provided since 2002 by pharmacists in Swiss nursing homes. SETTING: The setting was 42 nursing homes located in the canton of Fribourg, Switzerland under the responsibility of 22 pharmacists. METHOD: We developed different facilitators, such as a monitoring system, a coaching program, and a research project, to help pharmacists change their practice and to improve implementation of this new service. We evaluated the implementation rate of the service delivered in nursing homes. We assessed the economic impact of the service since its start in 2002 using statistical evaluation (Chow test) with retrospective analysis of the annual drug costs per resident over an 8-year period (1998-2005). MAIN OUTCOME MEASURES: The description of the facilitators and their implications in implementation of the service; the economic impact of the service since its start in 2002. RESULTS: In 2005, after a 4-year implementation period supported by the introduction of facilitators of practice change, all 42 nursing homes (2,214 residents) had implemented the pharmaceutical care service. The annual drug costs per resident decreased by about 16.4% between 2002 and 2005; this change proved to be highly significant. The performance of the pharmacists continuously improved using a specific coaching program including an annual expert comparative report, working groups, interdisciplinary continuing education symposia, and individual feedback. This research project also determined priorities to develop practice guidelines to prevent drug-related problems in nursing homes, especially in relation to the use of psychotropic drugs. CONCLUSION: The pharmaceutical care service was fully and successfully implemented in Fribourg's nursing homes within a period of 4 years. These findings highlight the importance of facilitators designed to assist pharmacists in the implementation of practice changes. The economic impact was confirmed on a large scale, and priorities for clinical and pharmacoeconomic research were identified in order to continue to improve the quality of integrated care for the elderly.

Gap Tuition Program, FY2014,

The Gap Tuition program was established to provide funding to community colleges for need-based tuition assistance to applicants for completion of continuing education certificate training programs for in-demand occupations.

Mississippi Drive (Iowa 92) from Main Street to the Norbert F. Beckey Bridge in Muscatine, Iowa, STP-U-5330(614)—27-70, Muscatine County, 2015

The proposed action consists of upgrading Mississippi Drive (Iowa Highway 92) through downtown Muscatine, Iowa. The Mississippi Drive Corridor Project begins south of the Main Street/Grandview Avenue intersection, continuing to the East 2nd Street/Norbert F. Beckey Bridge intersection, which marks the end of the project. It passes through a mix of commercial, residential, Central Business District and industrial land uses. The total length of the project is approximately 1.6 miles, including 19 intersections (6 with traffic signals). Refer to the vicinity map on Figure 1. The current roadway is a 3- to 4-lane, urban facility with both divided and undivided medians. The roadway, ranging from 40 to 64 feet wide, is considered difficult to cross for pedestrians, especially for small children or elderly. The width of this roadway is being considered to be narrowed to improve the accessibility to the downtown from the Mississippi River riverfront area by pedestrians. This project also includes accommodations for bicycles and pedestrians and measures to reduce flooding on the roadway.

Iowa In Motion: State Transportation Plan, 1997

What is Iowa in Motion? The Iowa Department of Transportation is continuing the journey to develop Iowa’s future transportation system. This ongoing planning process, known as Iowa in Motion, was developed in response to the Intermodal Surface Transportation Efficiency Act (ISTEA) and Iowa’s changing transportation needs. The completion of Parts I, II and III of Iowa in Motion has led to development of this State Transportation Plan. Part IV includes activities, both current and future, to support the plan. This State Transportation Plan represents the thoughts and concerns of thousands of Iowans. Individuals, metropolitan planning organizations (MPOs), regional planning affiliations (RPAs), associations and organizations have become involved and have made recommendations concerning which direction should be followed regarding transportation investments. This plan represents their extensive input into the Iowa in Motion process and consensus building as we moved towards adoption of this State Transportation Plan. The adopted plan serves as a guide for development of transportation policies, goals, objectives, initiatives and investment decisions through the year 2020.

Deploying the Maintenance Decision Support System (MDSS) in Iowa, 2003

Adverse weather conditions dramatically affect the nation’s surface transportation system. The development of a prototype winter Maintenance Decision Support System (MDSS) is part of the Federal Highway Administration’s effort to produce a prototype tool for decision support to winter road maintenance managers to help make the highways safer for the traveling public. The MDSS is based on leading diagnostic and prognostic weather research capabilities and road condition algorithms, which are being developed at national research centers. In 2003, the Iowa Department of Transportation was chosen as a field test bed for the continuing development of this important research program. The Center for Transportation Research and Education assisted the Iowa Department of Transportation by collecting and analyzing surface condition data. The Federal Highway Administration also selected five national research centers to participate in the development of the prototype MDSS. It is anticipated that components of the prototype MDSS system developed by this project will ultimately be deployed by road operating agencies, including state departments of transportation, and generally supplied by private vendors.

06033-015 Fox River Watershed Final Report

With WIRB funding the Fox River Ecosystem Development board will install prioritized practices identified by assessments within the impaired segment of Fox River that currently will not be funded by Iowa Section 319 or Watershed Protection Funds. The FRED board is also asking for funding for a three year position for continuing assessment, planning, and technical assistance. Through various funding sources local work groups have been able to address some of the critical and high priority areas. But, as further assessments are made, commitment, and need expressed from landowners grow, the FRED board and SWCD districts in both Iowa and Missouri are committed not only to seek funding to continue water quality efforts for more practices but also enhance and protect existing practices and investments that protect our water quality and economic viability in both states.