Alternatives for Rural Roads, HR-242, 1989

Much of the nation's rural road system is deteriorating. Many of the roads were built in the 1880s and 1890s with the most recent upgrading done in the 1940s and 1950s. Consequently, many roads and bridges do not have the capacity for the increased loads, speed, and frequent use of today's vehicles. Because of the growing demands and a dense county road system (inherited from the land settlement policies two centuries ago), revenue available to counties is inadequate to upgrade andmaintain the present system. Either revenue must be increased - an unpopular option - or costs must be reduced. To examine cost-saving options, Iowa State University conducted a study of roads and bridges in three 100 square mile areas in Iowa: • A suburban area • A rural area with a large number of paved roads, few bridges, and a high agricultural tax base and •A more rural area in a hilly terrain with many bridges and gravel roads, and a low agricultural tax base. A cost-benefit analysis was made on the present road system in these areas on such options as abandoning roads with limited use, converting some to private drives, and reducing maintenance on these types of roads. In only a few instances does abandonment of low traffic volume roads produce cost savings for counties and abutting land owners that exceed the additional travel costs to the public. In this study, the types of roads that produced net savings when abandoned were: • A small percentage (less than 5 percent) of the nonpaved county roads in the suburban area. However, net savings were very small. Cost savings from reducing the county road system in urbanized areas are very limited. • Slightly more than 5 percent of the nonpaved county roads in the most rural area that had a small number of paved county roads. • More than 12 percent of the nonpaved roads in the rural area that had a relatively large number of paved county and state roads. Converting low-volume roads to low-maintenance or Service B roads produces the largest savings of all solutions considered. However, future bridge deterioration and county liability on Service B roads are potential problems. Converting low-volume roads to private drives also produces large net savings. Abandonment of deadend roads results in greater net savings than continuous roads. However, this strategy shifts part of the public maintenance burden to land owners. Land owners also then become responsible for accident liability. Reconstruction to bring selected bridges with weight restrictions up to legal load limits reduces large truck and tractor-wagon mileage and costs. However, the reconstruction costs exceeded the reduction in travel costs. Major sources of vehicle miles on county roads are automobiles used for household purposes and pickup truck travel for farm purposes. Farm-related travel represents a relatively small percent of total travel miles, but a relatively high percentage of total travel costs.

Reinforced Slope with Geogrids, HR-548, 1997

The objective of this research study is to evaluate the performance, maintenance requirements and cost effectiveness of constructing reinforced slope along a concrete bikeway overpass with a Geogrid system such as manufactured by Tensar Corporation or Reinforced Earth Company. This final report consists of two separate reports - construction and performance. An earlier design report and work plan was submitted to the Iowa DOT in 1989. From the Design Report, it was determined that the reinforced slope would be the most economical system for this particular bikeway project. Preliminary cost estimates for other design alternatives including concrete retaining walls, gabions and sheet pile walls ranged from $204/L.F. to $220/L.F. The actual final construction cost of the reinforced slope with GEDGRIDS was around $112/L.F. Although, since the reinforced slope system was not feasible next to the bridge overpass because of design constraints, a fair cost comparison should reflect costs of constructing a concrete retaining wall. Including the concrete retaining wall costs raises the per lineal foot cost to around $122/L.F. In addition to this initial construction cost effectiveness of the reinforced slope, there has been little or no maintenance needed for this reinforced slope. It was noted that some edge mowing or weed whacking could be done near the concrete bikeway slab to improve the visual quality of the slope, but no work has been assigned to city crews. It was added that this kind of weed whacking over such steep slope is more difficult and there could possibly be more potential for work related injury. The geogrid reinforced slope has performed really well once the vegetation took control and prevented soil washing across the bikeway slab. To that end, interim erosion control measures might need to be considered in future projects. Some construction observations were noted. First, there i s no specialized experience or equipment required for a contractor to successfully build a low-to-medium geogrid reinforced slope structure. Second, the adaptability of the reinforced earth structure enables the designer to best fit the shape of the structure to the environment and could enhance aesthetic quality. Finally, a reinforced slope can be built with relatively soft soils provided differential settlements between facing are limited to one or two percent.

Evaluation of Long-Term Field Performance of Cold In-Place Recycled Roads: Field Distress Survey, TR-502, 2007

Cold in-place recycling (CIR) has become an attractive method for rehabilitating asphalt roads that have good subgrade support and are suffering distress related to non-structural aging and cracking of the pavement layer. Although CIR is widely used, its use could be expanded if its performance were more predictable. Transportation officials have observed roads that were recycled under similar circumstances perform very differently for no clear reason. Moreover, a rational mix design has not yet been developed, design assumptions regarding the structural support of the CIR layer remain empirical and conservative, and there is no clear understanding of the cause-effect relationships between the choices made during the design/construction process and the resulting performance. The objective of this project is to investigate these relationships, especially concerning the age of the recycled pavement, cumulative traffic volume, support conditions, aged engineering properties of the CIR materials, and road performance. Twenty-four CIR asphalt roads constructed in Iowa from 1986 to 2004 were studied: 18 were selected from a sample of roads studied in a previous research project (HR-392), and 6 were selected from newer CIR projects constructed after 1999. This report summarizes the results of a comprehensive program of field distress surveys, field testing, and laboratory testing for these CIR asphalt roads. The results of this research can help identify changes that should be made with regard to design, material selection, and construction in order to lengthen the time between rehabilitation cycles and improve the performance and cost-effectiveness of future recycled roads.

Community pharmacist intervention in depressed primary care patients (PRODEFAR study): randomized controlled trial protocol.

Background: Treatment of depression, the most prevalent and costly mental disorder, needs to be improved. Non-concordance with clinical guidelines and non-adherence can limit the efficacy of pharmacological treatment of depression. Through pharmaceutical care, pharmacists can improve patients' compliance and wellbeing. The aim of this study is to evaluate the effectiveness and costeffectiveness of a community pharmacist intervention developed to improve adherence and outcomes of primary care patients with depression. Methods/design: A randomized controlled trial, with 6-month follow-up, comparing patients receiving a pharmaceutical care support programme in primary care with patients receiving usual care. The total sample comprises 194 patients (aged between 18 and 75) diagnosed with depressive disorder in a primary care health centre in the province of Barcelona (Spain). Subjects will be asked for written informed consent in order to participate in the study. Diagnosis will be confirmed using the SCID-I. The intervention consists of an educational programme focused on improving knowledge about medication, making patients aware of the importance of compliance, reducing stigma, reassuring patients about side-effects and stressing the importance of carrying out general practitioners' advice. Measurements will take place at baseline, and after 3 and 6 months. Main outcome measure is compliance with antidepressants. Secondary outcomes include; clinical severity of depression (PHQ-9), anxiety (STAI-S), health-related quality of life (EuroQol-5D), satisfaction with the treatment received, side-effects, chronic physical conditions and sociodemographics. The use of healthcare and social care services will be assessed with an adapted version of the Client Service Receipt Inventory (CSRI). Discussion: This trial will provide valuable information for health professionals and policy makers on the effectiveness and cost-effectiveness of a pharmaceutical intervention programme in the context of primary care. Trial registration: NCT00794196

Subsidy design: wealth versus benefits

A government would like to subsidize an indivisible good. Consumers' valuations of the good vary according to their wealth and benefits from the good. A subsidy scheme may be based on consumers' wealth or benefit information. We translate a wealth-based policy to a benefit-based policy, and vice versa, and give a necessary and sufficient condition for the pair of policies to implement the same assignment: consumers choose to purchase the good under the wealth-based policy if and only if they choose to do so under the translated benefit-based policy. General taxation allows equivalent policies to require the same budget.

Knochenanabole Therapie mit Teriparatid [Bone anabolic treatment with Teriparatide].

The recombinant amino-terminal fragment of human parathyroid hormone (Teriparatide) is a bone anabolic agent which reduces fracture risk by increasing bone mass and improving bone microarchitecture. Teriparatide reduces vertebral fracture risk by 65 % and non-vertebral by 50 %. Its efficacy is higher as bisphosphonates to prevent corcicosteroid-induced osteoporosis. Teriparatide may also have a direct effect on bone pain. Teriparatide may be initiating immediately after an anticatabolic agent. However, it is not recommended to associate both treatments. At the end of teripatide treatment, an anticatabolic agent may be given. According to cost-effectiveness studies, Teriparatide should be considered as first line treatment for postmenopausal women and for men with severe osteoporosis.

La "bientraitance", exploration du concept et essai d'utilisation en santé publique: une expérience à Fribourg (Suisse). ["Bientraitance": conceptual exploration and an example of its application in public health: an experience from Fribourg, Switzerland]

Since the year 2000, the concept of "bientraitance" (for which no equivalent term has yet emerged in either the English or German language) has gained widespread credence among educators, sociologists and health professionals in France and Belgium. This concept emphasizes a constructive approach to care and education rather than merely one of prevention of disasters. Applied in public health, and in particular to mental health promotion, the use of the concept of "bientraitance" can help promote both effectiveness and meaning in the design and planning of community interventions. The article presents an example of an intervention for children and adolescents in Fribourg, Switzerland. The underpinning hypothesis is that the children and youth groups (such as sports clubs, artistic and cultural associations, scouts and guides) represent largely untapped, or under-tapped, informal health resources with a favourable cost-effectiveness profile. "Bientraitance" criteria are used in selecting certain associations offering structured extracurricular group educational activities and collective out-of-school (or after school) programmes. Support is provided to the organisations selected for recruiting new members, in particular those with potentially lower levels of access, for example disabled children or new migrants. The results will be evaluated for the impact of participation in various out-of-school activities on health and health determinants from a prospective and comparative perspective. This paper shows how the concept of "bientraitance" can be useful in the development of a public health intervention.

Evaluation of Long-Term Field Performance of Cold In-Place Recycled Roads: Field and Laboratory Testing, TR-502, 2007

Cold in-place recycling (CIR) has become an attractive method for rehabilitating asphalt roads that have good subgrade support and are suffering distress related to non-structural aging and cracking of the pavement layer. Although CIR is widely used, its use could be expanded if its performance were more predictable. Transportation officials have observed roads that were recycled under similar circumstances perform very differently for no clear reason. Moreover, a rational mix design has not yet been developed, design assumptions regarding the structural support of the CIR layer remain empirical and conservative, and there is no clear understanding of the cause-effect relationships between the choices made during the design/construction process and the resulting performance. The objective of this project is to investigate these relationships, especially concerning the age of the recycled pavement, cumulative traffic volume, support conditions, aged engineering properties of the CIR materials, and road performance. Twenty-four CIR asphalt roads constructed in Iowa from 1986 to 2004 were studied: 18 were selected from a sample of roads studied in a previous research project (HR-392), and 6 were selected from newer CIR projects constructed after 1999. This report describes the results of comprehensive field and laboratory testing for these CIR asphalt roads. The results indicate that the modulus of the CIR layer and the air voids of the CIR asphalt binder were the most important factors affecting CIR pavement performance for high-traffic roads. For low-traffic roads, the wet indirect tensile strength significantly affected pavement performance. The results of this research can help identify changes that should be made with regard to design, material selection, and construction in order to improve the performance and cost-effectiveness of future recycled roads.

Evaluation of Long-Term Field Performance of Cold In-Place Recycled Roads: Summary Report, TR-502, 2007

Cold in-place recycling (CIR) has become an attractive method for rehabilitating asphalt roads that have good subgrade support and are suffering distress related to non-structural aging and cracking of the pavement layer. Although CIR is widely used, its use could be expanded if its performance were more predictable. Transportation officials have observed roads that were recycled under similar circumstances perform very differently for no clear reason. Moreover, a rational mix design has not yet been developed, design assumptions regarding the structural support of the CIR layer remain empirical and conservative, and there is no clear understanding of the cause-effect relationships between the choices made during the design/construction process and the resulting performance. The objective of this project is to investigate these relationships, especially concerning the age of the recycled pavement, cumulative traffic volume, support conditions, aged engineering properties of the CIR materials, and road performance. Twenty-four CIR asphalt roads constructed in Iowa from 1986 to 2004 were studied: 18 were selected from a sample of roads studied in a previous research project (HR-392), and 6 were selected from newer CIR projects constructed after 1999. This report summarizes the results of a comprehensive program of field distress surveys, field testing, and laboratory testing for these CIR asphalt roads. The results of this research can help identify changes that should be made with regard to design, material selection, and construction in order to lengthen the time between rehabilitation cycles and improve the performance and cost-effectiveness of future recycled roads.

Education on Urban Corridor Issues Through Computer Animation, TR-419, 2003

This project was undertaken in coordination with the Environmental Assessment process on the Mt. Vernon Road Improvements project in Cedar Rapids, Iowa. The goal of the research was to determine the cost effectiveness of combined photo-imaging and computer animation as a presentation tool describing public road improvements. The Public Hearing, in combination with the involvement of a Citizen's Resource Group, afforded an opportunity to have an evaluation of the processes by interested citizens who were not familiar with engineering drawings or the construction industry. After the initial viewing of a draft version of the video, the Resource Group made recommendations to the staff developing the video. Discussion of these recommendations led to the development of an animated composite section that showed a combination of situations typically encountered throughout the project corridor, as well as critical considerations. The composite section did not show specific locations and therefore, individuals were not distracted by looking for the details pertaining to their properties. Concentration on the concepts involved rather than specifics provided the opportunity for a more thorough understanding by the citizens. The development of the composite concept was the primary discovery of the research.

Population based screening - the difficulty of how to do more good than harm and how to achieve it.

Screening people without symptoms of disease is an attractive idea. Screening allows early detection of disease or elevated risk of disease, and has the potential for improved treatment and reduction of mortality. The list of future screening opportunities is set to grow because of the refinement of screening techniques, the increasing frequency of degenerative and chronic diseases, and the steadily growing body of evidence on genetic predispositions for various diseases. But how should we decide on the diseases for which screening should be done and on recommendations for how it should be implemented? We use the examples of prostate cancer and genetic screening to show the importance of considering screening as an ongoing population-based intervention with beneficial and harmful effects, and not simply the use of a test. Assessing whether screening should be recommended and implemented for any named disease is therefore a multi-dimensional task in health technology assessment. There are several countries that already use established processes and criteria to assess the appropriateness of screening. We argue that the Swiss healthcare system needs a nationwide screening commission mandated to conduct appropriate evidence-based evaluation of the impact of proposed screening interventions, to issue evidence-based recommendations, and to monitor the performance of screening programmes introduced. Without explicit processes there is a danger that beneficial screening programmes could be neglected and that ineffective, and potentially harmful, screening procedures could be introduced.