Iowa Vocational Rehabilitation Services Performance Plan, FY 2014

Agency Performance Plan, Iowa Vocational Rehabilitation Services

Iowa Vocational Rehabilitation Services Performance Plan, FY 2013

Agency Performance Plan, Iowa Vocational Rehabilitation Services

Iowa Vocational Rehabilitation Services Performance Plan, FY 2013

Agency Performance Plan, Iowa Vocational Rehabilitation Services

Iowa Vocational Rehabilitation Services Strategic Plan, 2011-2014

This report outlines the strategic plan for Iowa Vocational Rehabilitation Services including, goals and mission.

La cohorte sepsis lausannoise: une opportunité de développer la recherche dans le Réseau latin de médecine intensive [Lausanne Cohort of septic patients as an opportunity to develop multidisciplinary research within the Swiss Latin Network of Intensive Care Medicine]

Despite recent medical progresses in patient support, the mortality of sepsis remains high. Recently, new supporting strategies were proposed to improve outcome. Whereas such strategies are currently considered as standard of care, their real impact on mortality, morbidity, length of stay, and hence, health care resources utilization has been only weakly evaluated so far. Obviously, there is a critical need for epidemiologic surveys of sepsis to better address these major issues. The Lausanne Cohort of septic patients aims at building a large clinical, biological and microbiological database that will be used as a multidisciplinary research platform to study the various pathogenic mechanisms of sepsis in collaboration with the various specialists. This could be an opportunity to strengthen the collaboration within the Swiss Latin network of Intensive Care Medicine.

Improvement of cardiovascular risk prediction: time to review current knowledge, debates, and fundamentals on how to assess test characteristics.

Cardiovascular risk assessment might be improved with the addition of emerging, new tests derived from atherosclerosis imaging, laboratory tests or functional tests. This article reviews relative risk, odds ratios, receiver-operating curves, posttest risk calculations based on likelihood ratios, the net reclassification improvement and integrated discrimination. This serves to determine whether a new test has an added clinical value on top of conventional risk testing and how this can be verified statistically. Two clinically meaningful examples serve to illustrate novel approaches. This work serves as a review and basic work for the development of new guidelines on cardiovascular risk prediction, taking into account emerging tests, to be proposed by members of the 'Taskforce on Vascular Risk Prediction' under the auspices of the Working Group 'Swiss Atherosclerosis' of the Swiss Society of Cardiology in the future.

Prognostication in comatose survivors of cardiac arrest: An advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine.

OBJECTIVES: To review and update the evidence on predictors of poor outcome (death, persistent vegetative state or severe neurological disability) in adult comatose survivors of cardiac arrest, either treated or not treated with controlled temperature, to identify knowledge gaps and to suggest a reliable prognostication strategy. METHODS: GRADE-based systematic review followed by expert consensus achieved using Web-based Delphi methodology, conference calls and face-to-face meetings. Predictors based on clinical examination, electrophysiology, biomarkers and imaging were included. RESULTS AND CONCLUSIONS: Evidence from a total of 73 studies was reviewed. The quality of evidence was low or very low for almost all studies. In patients who are comatose with absent or extensor motor response at ?72h from arrest, either treated or not treated with controlled temperature, bilateral absence of either pupillary and corneal reflexes or N20 wave of short-latency somatosensory evoked potentials were identified as the most robust predictors. Early status myoclonus, elevated values of neuron specific enolase at 48-72h from arrest, unreactive malignant EEG patterns after rewarming, and presence of diffuse signs of postanoxic injury on either computed tomography or magnetic resonance imaging were identified as useful but less robust predictors. Prolonged observation and repeated assessments should be considered when results of initial assessment are inconclusive. Although no specific combination of predictors is sufficiently supported by available evidence, a multimodal prognostication approach is recommended in all patients.

Pipe Rehabilitation with Polyethylene Pipe Liners, HR-370, 2003

Corroded, deteriorated, misaligned, and distorted drainage pipes can cause a serious threat to a roadway. Normal practice is to remove and replace the damaged drainage structure. An alternative method of rehabilitating these structures is to slip line them with a polyethylene liner. Twelve drainage structures were slip lined with polyethylene liners during 1994 in Iowa. Two types of liners installed were "Culvert Renew" and "Snap-Tite." It was found that the liners could be easily installed by most highway, county, and city maintenance departments. The liners restore the flow and increase the service life of the original drainage structure. The liners were found to be cost competitive compared with the removal and replacement of the existing drainage structure. Slip lining has the largest economic benefit when the roadway is paved, the culvert is under a deep fill, or traffic volumes are high. The annular space between the original pipe and the liner was filled with flowable mortar. Care should be taken to properly brace and grout the annular space between the liner and the culvert to avoid deformation of the liner.

Manual for Evaluation, Rehabilitation and Strengthening of Low Volume Bridges, HR-323, 1993

This report contains an evaluation and design manual for strengthening and replacing low volume steel stringer and timber stringer bridges. An advisory panel consisting of county and municipal engineers provided direction for the development of the manual. NBI bridge data, along with results from questionnaires sent to county and municipal engineers were used to formulate the manual. Types of structures shown to have the greatest need for cost-effective strengthening methods are steel stringer and timber stringer bridges. Procedures for strengthening these two types of structures have been developed. Various types of replacement bridges have also been included so that the most cost effective solution for a deficient bridge may be obtained. The key results of this study is an extensive compilation, which can be used by county engineers, of the most effective techniques for strengthening deficient existing bridges. The replacement bridge types included have been used in numerous low volume applications in surrounding states, as well as in Iowa. An economic analysis for determining the cost-effectiveness of the various strengthening methods and replacement bridges is also an important part of the manual. Microcomputer spreadsheet software for several of the strengthening methods, types of replacement bridges and for the economic analysis has been developed, documented and presented in the manual. So the manual, Chp. 3 of the final report, can be easily located, blue divider pages have been inserted to delineate the manual from the rest of the report.

Défis et opportunités liés a la création d'une société unique de spécialistes en médecine interne générale en 2015 [Challenges and opportunities related to the creation of a unique society of specialists in general internal medicine in 2015].

A common training plan in general internal medicine was a brave enterprise started in 2011 in accordance with the common objectives of the Swiss Society of General Medicine and the Swiss Society of Internal Medicine. The next challenge will be the dissolution of the two Societies and therefore the creation of an unique new association in 2015. This is an extraordinary opportunity to bring together the specific qualities of each association and to create a new society. Issues, objectives and secondary benefits expected from the creation of the largest national society of a medical discipline are explored as a joint discussion in this article.

Bridge Deck Rehabilitation Rebonding a Delaminated PCC Overlay By Epoxy Injection, HR-1036, 1989

The Iowa demonstration project to promote the rehabilitation of bridge deck concrete by rebonding delaminations with injected epoxy is a 150 ft x 150 ft high truss bridge on Iowa route No. 210 over Indian Creek near Maxwell in Story County (Service level D, AADT-730, Inventory Rating HS-16.9, Operating Rating HS-25). The objective of this study was to evaluate the effectiveness of repairing a delaminated bridge deck by epoxy injection, specifically a bridge deck with a delaminated portland cement concrete overlay. Observations noted during the project lead to the following conclusions: The delaminations rebonded with epoxy have remained solid through five years. The percentage of delamination has stayed essentially the same for both the epoxy injected and non-repaired areas. Epoxy injection appears to be a practical, cost effective alternative to other forms of deck rehabilitation when undertaken at the proper time. Cost effectiveness would reduce dramatically if delayed until breakouts have occurred. On the other hand it would be a slow, labor intensive process if undertaken too early when delaminations are small.

International perspectives on general internal medicine and the case for "globalization" of a discipline.

General internal medicine (GIM) has flourished in the United States (U.S.). Unlike other subspecialties of internal medicine, however, GIM's evolution has not been global in scope, but rather appears to have occurred in isolation within countries. Here, we describe international models of GIM from Canada, Switzerland, Australia/New Zealand, Argentina, and Japan, and compare these with the U.S. model. There are notable differences in the typical clinical roles assumed by General Internists across these 7 countries, but also important overlap in clinical and academic domains. Despite this overlap, there has been a relative lack of contact among General Internists from these and other countries at a truly international GIM meeting; the time is now for increased international exchange and the "globalization" of GIM.

Enseignement de la médecine de famille: nouvelles évolutions à Lausanne [Teaching family medicine in Lausanne].

The Faculty of Biology and Medicine of Lausanne has integrated education of family medicine all along its new undergraduate medical curriculum. The Institute of general medicine is in charge to implement those offers among which two are presented hereafter. In the new module "Generalism" several courses cover the specificities of the discipline as for example medical decision in the practice. A mandatory one-month internship in the medical practice offers an experiential immersion into family medicine for all students. In a meeting at the end of their internship, students discuss in group with their peers their individual experiences and are asked to identify, based on their personal experience, the general concepts of the specialty of family medicine and general practice.