Department of Commerce - Iowa Utilities Board, Performance Report, Performance Results Achieved for Fiscal Year 2015

This report highlights the services the IUB provided to Iowans, along with results achieved to ensure reliability, and to improve and expand utility service infrastructure in Iowa. This information is provided in accordance with the State of Iowa Accountable Government Act, Iowa Code chapter 8E. The two basic business functions of the IUB are utility regulation and compliance, and resource management. This report covers performance information for both of these areas.

Midwest Regional Rail Passenger Initiative and Passenger Rail Service in Iowa status report

This report provides the status of the Passenger Rail Service Revolving Fund and the development and operation of the Midwest regional rail system and the state’s passenger rail service.

Iowa Department of Public Health Affordable Care Act Impact Study, October 27, 2014

The mission of the Iowa Department of Public Health (IDPH) is “Promoting and Protecting the Health of Iowans.” In addition to its larger role in population health preparedness, surveillance, and response, IDPH has historically funded a broad array of health-related services to a “covered population” of approximately 1,000,000 Iowa residents through a varied network of local community-based “safety-net” provider contractors. Those health-related services range from funding direct healthcare services like immunizations and vision screening to providing or funding facilitative services like transportation and care coordination. While all Iowans may be eligible for some IDPH-funded direct healthcare service, such as smoking cessation, the individuals most often eligible for these services have traditionally been the uninsured and under-insured. As uninsured Iowans become enrolled in health plan options available through the Iowa Health and Wellness Plan (IHAWP) and the Marketplace, IDPH anticipates that many direct healthcare services funded by IDPH will become covered benefits or services under new plans, changing the demand for IDPH-funded services.

Service Station Sales in Eight Iowa Cities, 1963

What is the trend in service station sales and how does a change in the traffic pattern affect this trend? This report is a study of service station sales in eight Iowa cities that are experiencing changes in traffic patterns. The cities are: 1. Albia 2. Boone 3. Chariton 4. Decorah 5. Grinnell 6. Jefferson 7. Newton 8. Stuart. The Interstate Highway by-passes Newton, Grinnell and Stuart. Primary highways are being relocated around Boone, Decorah, and Albia. Primary highway relocations have been completed around Chariton and Jefferson.

Stab wounds in a Swiss emergency department: a series of 80 consecutive cases.

Background: Interpersonal violence is a worldwide social reality which seems to increasingly affect even the safest of countries, such as Switzerland. In this country, road traffic accidents, as well as professional and recreational activities, are the main providers of trauma-related injuries. The incidence of penetrative trauma related to stab wounds seems to be regularly increasing in our ED. The question arises of whether our strategies in trauma management are adapted to deal efficiently with these injuries.Methods: To answer this question, the study analysed patients admitted for intentional penetrative injuries in a tertiary urban emergency department (ED) during a 23 month period. Demographics, conditions of the assault, injury type and treatments applied were analysed.Results: Eighty patients admitted due to an intentional penetrating trauma accounted for 0.2% of the surgical practice of our ED. The assault occurred equally in a public or a private context, mainly affecting young males during the night and the weekend. Sixty six patients (83%) were treated as out-patients. Only 10 patients needed surgery. None of them required damage control surgery. No patient died and the mean hospital stay was 5.5 days.Conclusions: The prevalence of stab wounds in Switzerland is low. These injuries rarely need complex, surgical procedures. Observational strategies should be considered according to the patient status.

Investigation of Rapid Thermal Analysis Procedures for Prediction of the Service Life of PCCP Carbonate Coarse Aggregate: Phase I, Progress Report, HR-337, 1992

The major objective of this research project is to utilize thermal analysis techniques in conjunction with x-ray analysis methods to identify and explain chemical reactions that promote aggregate related deterioration in Portland cement concrete. The first year of this project has been spent obtaining and analyzing limestone and dolomite samples that exhibit a wide range of field service performance. Most of the samples chosen for the study also had laboratory durability test information (ASTM C 666, method B) that was readily available. Preliminary test results indicate that a strong relationship exists between the average crystallite size of the limestone (calcite) specimens and their apparent decomposition temperatures as measured by thermogravimetric analysis. Also, premature weight loss in the thermogravimetric analysis tests appeared to be related to the apparent decomposition temperature of the various calcite test specimens.

Ultimate Load Behavior of Full-Scale Highway Truss Bridges: Phase II - Service Load and Supplementary Tests, Interim Report, HR-169, 1975

As a result of the construction of the Saylorville Dam and Reservoir on the Des Moines River, six highway bridges crossing the river were scheduled for removal. Two of these were incorporated into a comprehensive test program to study the behavior of old pin-connected high-truss single-lane bridges. The test program consisted of ultimate load tests, service load tests and a supplementary test program. The results reported in this report cover the service load tests on the two bridges as well as the supplementary tests, both static and fatigue, of eyebar members removed from the two bridges. The field test results of the service loading are compared with theoretical results of the truss analysis.

Social and medical vulnerability factors of frequent users at the emergency department: a case-control study

BACKGROUND: Up to 5% of patients presenting to the emergency department (ED) four or more times within a 12 month period represent 21% of total ED visits. In this study we sought to characterize social and medical vulnerability factors of ED frequent users (FUs) and to explore if these factors hold simultaneously. METHODS: We performed a case-control study at Lausanne University Hospital, Switzerland. Patients over 18 years presenting to the ED at least once within the study period (April 2008 toMarch 2009) were included. FUs were defined as patients with four or more ED visits within the previous 12 months. Outcome data were extracted from medical records of the first ED attendance within the study period. Outcomes included basic demographics and social variables, ED admission diagnosis, somatic and psychiatric days hospitalized over 12 months, and having a primary care physician.We calculated the percentage of FUs and non-FUs having at least one social and one medical vulnerability factor. The four chosen social factors included: unemployed and/or dependence on government welfare, institutionalized and/or without fixed residence, either separated, divorced or widowed, and under guardianship. The fourmedical vulnerability factors were: ≥6 somatic days hospitalized, ≥1 psychiatric days hospitalized, ≥5 clinical departments used (all three factors measured over 12 months), and ED admission diagnosis of alcohol and/or drug abuse. Univariate and multivariate logistical regression analyses allowed comparison of two JGIM ABSTRACTS S391 random samples of 354 FUs and 354 non-FUs (statistical power 0.9, alpha 0.05 for all outcomes except gender, country of birth, and insurance type). RESULTS: FUs accounted for 7.7% of ED patients and 24.9% of ED visits. Univariate logistic regression showed that FUs were older (mean age 49.8 vs. 45.2 yrs, p=0.003),more often separated and/or divorced (17.5%vs. 13.9%, p=0.029) or widowed (13.8% vs. 8.8%, p=0.029), and either unemployed or dependent on government welfare (31.3% vs. 13.3%, p<0.001), compared to non-FUs. FUs cumulated more days hospitalized over 12 months (mean number of somatic days per patient 1.0 vs. 0.3, p<0.001; mean number of psychiatric days per patient 0.12 vs. 0.03, p<0.001). The two groups were similar regarding gender distribution (females 51.7% vs. 48.3%). The multivariate linear regression model was based on the six most significant factors identified by univariate analysis The model showed that FUs had more social problems, as they were more likely to be institutionalized or not have a fixed residence (OR 4.62; 95% CI, 1.65 to 12.93), and to be unemployed or dependent on government welfare (OR 2.03; 95% CI, 1.31 to 3.14) compared to non-FUs. FUs were more likely to need medical care, as indicated by involvement of≥5 clinical departments over 12 months (OR 6.2; 95%CI, 3.74 to 10.15), having an ED admission diagnosis of substance abuse (OR 3.23; 95% CI, 1.23 to 8.46) and having a primary care physician (OR 1.70;95%CI, 1.13 to 2.56); however, they were less likely to present with an admission diagnosis of injury (OR 0.64; 95% CI, 0.40 to 1.00) compared to non-FUs. FUs were more likely to combine at least one social with one medical vulnerability factor (38.4% vs. 12.1%, OR 7.74; 95% CI 5.03 to 11.93). CONCLUSIONS: FUs were more likely than non-FUs to have social and medical vulnerability factors and to have multiple factors in combination.

Service Management for Service Desk

Palvelunhallinnan kehittäminen Service Desk ympäristöön johtaa parempaan työnkulun hallintaan. Service Deskin päätehtävänä on toimia ainoana yhteyspisteenä asiakkaalta tietohallinto-osastolle. Jokainen yhteydenottopitää kirjata ja se pitäisi olla jäljitettävissä. Tapahtumien eli insidenttien kirjaaminen tapahtuu pääasiassa Service Desk -funktiossa, joka omistaa niistä jokaisen. Tapahtumien hallintaprosessin tehtävänä on etsiä loppukäyttäjän tai IT-infrastruktuurin monitorointityökalun ilmoittamalle insidentille mahdollisimman nopea ratkaisu. Insidentit saattavat johtaa ongelmiin, jotka käsitellään erillisessä prosessissa. Ongelmien hallintaprosessi yrittää etsiä vikatilanteen pohjimmaisen syyn. Kun pohjimmaisin syy on löytynyt, prosessi lähettää muutospyynnön muutosten hallintaprosessille. Jotta päästään mahdollisimman hyvään tehokkuuteen, pitää määrittää asiakasrajapinta sekä mittarit. ITIL-malli tarjoaa prosessit IT-palvelunhallinnan kehittämiselle. Kansainvälisesti tunnettuna 'de factO' standardina sitä voidaan soveltaa globaaleissa yrityksissä. Tässä työssä keskitytään erään lääkkeiden jakelussa toimivan yrityksen tietohallinto-osaston Help Deskin nykytilan määrittämiseen. Työssä myös kuvataan tietohallinto-osaston tavoitetila, jossa keskitytään Service Deskin IT palvelunhallinnan kehittämiseen. Muut prosessit ja mittarit on kuvattu niiltä osin, jotka tulee huomioida Service Deskin seuraamisen ja ohjaamisen kannalta.

Primary fluid bolus therapy for infection-associated hypotension in the emergency department.

OBJECTIVES: The physiological changes associated with fluid bolus therapy (FBT) for patients with infection-associated hypotension in the emergency department (ED) are poorly understood. We describe the physiological outcomes of FBT in the first 6 hours (primary FBT) for patients presenting to the ED with infection-associated hypotension. METHODS: We studied 101 consecutive ED patients with infection and a systolic blood pressure (SBP)<100 mmHg who underwent FBT in the first 6 hours. RESULTS: We screened 1123 patients with infection and identified 101 eligible patients. The median primary FBT volume given was 1570 mL (interquartile range, 1000- 2490 mL). The average mean arterial pressure (MAP) did not change from admission to 6 hours in the whole cohort, or in patients who were hypotensive on arrival at the ED. However, the average MAP increased from its lowest value during the first 6 hours (66 mmHg [SD, 10 mmHg]) to its value at 6 hours (73 mmHg [SD, 12 mmHg]; P<0.001). The mean heart rate, body temperature, respiratory rate and plasma creatinine level decreased (P<0.05). In patients who were severely hypotensive (SBP<90 mmHg) on arrival at the ED, the MAP increased from 54 mmHg (SD, 8 mmHg) to 70 mmHg (SD, 14 mmHg) (P<0.001). At 6 hours, however, SBP was still <100 mmHg in 44 patients and <90 mmHg in 17 patients. When noradrenaline was used, in 10 patients, hypotension was corrected in all 10 and the MAP increased from 58 mmHg (SD, 9 mmHg) to 75 mmHg (SD, 13 mmHg). CONCLUSION: Among ED patients admitted to an Australian teaching hospital with infection, hypotension was uncommon. FBT for hypotension was limited in volumes given and failed to achieve a sustained SBP of >100 mmHg in 40% of cases. In contrast, noradrenaline therapy corrected hypotension in all patients who received it.

How to operate a university institute as a radiological emergency service?

The Institute of Radiation Physics (IRA) is attached to the Department of Medical Radiology at the Vaud University Hospital Center (CHUV) in Lausanne. The Institute's main tasks are strongly linked to the medical activities of the Department: radiotherapy, radiodiagnostics, interventional radiology and nuclear medicine. The Institute also works in the fields of operational radiation protection, radiation metrology and radioecology. In the case of an accident involving radioactive materials, the emergency services are able to call on the assistance of radiation protection specialists. In order to avoid having to create and maintain a specific structure, both burdensome and rarely needed, Switzerland decided to unite all existing emergency services for such events. Thus, the IRA was invited to participate in this network. The challenge is therefore to integrate a university structure, used to academic collaborations and the scientific approach, to an interventional organization accustomed to strict policies, a military-style command structure and "drilled" procedures. The IRA's solution entails mobilizing existing resources and the expertise developed through professional experience. The main asset of this solution is that it involves the participation of committed collaborators who remain in a familiar environment, and are able to use proven materials and mastered procedures, even if the atmosphere of an accident situation differs greatly from regular laboratory routines. However, this solution requires both a commitment to education and training in emergency situations, and a commitment in terms of discipline by each collaborator in order to be integrated into a response plan supervised by an operational command center.

User-driven community-based service development

This final thesis project was carried out in the Industrial Management department of University of Applied Sciences Stadia for Forum Virium Helsinki. The purpose of this study was to answer to the question of how companies can use online customer community of co-creation in service development and what is the value gained from it. The paper combines a range of recently published theoretical works and ongoing customer community case development. The study aims to provide new information and action approaches to new service developers that may increase the success of the community building process. The paper also outlines the benefits of the use of online customer community and offers practical suggestions for maximizing the value gained from the community in service development projects. The concepts and suggestions introduced in the study appear to have notable new possibilities to the service development process but they have to be further tested empirically. This paper describes the online consumer community of co-creation to an important organizational process of innovation management suggesting that it possesses a great value to business. Online customer communities offer a potential of improving the success of new services or products enabling early, penetrable market entry and creating sustainable competitive advantage.

Les déterminants de la prolongation des séjours en SSRG et les indicateurs du devenir des patients après leur sortie : Étude rétrospective au CHRU de Strasbourg [Determinants of prolonged stays in geriatric rehabilitation department and indicators of patient outcome after discharge: A retrospective study in Strasbourg university hospital]

Objectif. Analyser les déterminants de la prolongation des séjours hospitaliers en service de soins de suite et réadaptation gériatrique (SSRG) et identifier les indicateurs du devenir des patients après leur sortie. Méthode. Étude rétrospective au CHRU de Strasbourg de l'ensemble des séjours de durée supérieure à 90 jours entre le 1 janvier 2012 et le 30 septembre 2013. L'ensemble des données sociodémographiques, descriptives des séjours et de l'état de santé des patients ont été analysées. Les patients ont été suivis 9 mois après leur sortie. Les réhospitalisations, l'admission en institution et le décès ont été informés par un contact téléphonique auprès du médecin traitant ou de la famille. Résultats. Quarante-six séjours ont été analysés. Les patients étaient à 68,0 % des femmes. La moyenne d'âge était de 82,9 ± 5,8 ans. Quatre-vingt-dix-huit pour cent d'entre eux vivaient à domicile avant l'admission en milieu hospitalier. Les raisons justifiant la prolongation étaient d'ordre médical (60,8 %), psychique (45,6 %), social (65,2 %) et liées à la difficulté de trouver une solution d'aval (58,7 %). À la fin de leur séjour, 9 patients ont pu regagner leur domicile et 37 ont été admis directement en institution. Durant la période de suivi, 17 patients ont été réhospitalisés au moins une fois et 3 jusqu'à trois fois. Au 9e mois, 9 patients étaient décédés dans un délai moyen de 75 jours après la sortie du SSRG. Les résultats des analyses unifactorielles et multivariées ont permis d'identifier des indicateurs d'évolution défavorable (décès et/ou réhospitalisation). Aucune des variables sociodémographiques ou de syndrome gériatrique n'a été identifiée. Par contre un « motif d'hospitalisation pour une maladie infectieuse », ou pour « un trouble de la marche ou une chute », une « prolongation du séjour en SSRG pour raison médicale » et un « séjour prolongé en court séjour » étaient les facteurs identifiés. Conclusion. Dans la tendance actuelle à améliorer la rentabilité de l'utilisation des ressources de santé, ces résultats rappellent qu'il est important de maintenir un juste équilibre entre utilisation raisonnée des ressources et les besoins spécifiques des patients âgés.

Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: a controlled, cross-sectional study.

BACKGROUND: Frequent emergency department (ED) users meet several of the criteria of vulnerability, but this needs to be further examined taking into consideration all vulnerability's different dimensions. This study aimed to characterize frequent ED users and to define risk factors of frequent ED use within a universal health care coverage system, applying a conceptual framework of vulnerability. METHODS: A controlled, cross-sectional study comparing frequent ED users to a control group of non-frequent users was conducted at the Lausanne University Hospital, Switzerland. Frequent users were defined as patients with five or more visits to the ED in the previous 12 months. The two groups were compared using validated scales for each one of the five dimensions of an innovative conceptual framework: socio-demographic characteristics; somatic, mental, and risk-behavior indicators; and use of health care services. Independent t-tests, Wilcoxon rank-sum tests, Pearson's Chi-squared test and Fisher's exact test were used for the comparison. To examine the -related to vulnerability- risk factors for being a frequent ED user, univariate and multivariate logistic regression models were used. RESULTS: We compared 226 frequent users and 173 controls. Frequent users had more vulnerabilities in all five dimensions of the conceptual framework. They were younger, and more often immigrants from low/middle-income countries or unemployed, had more somatic and psychiatric comorbidities, were more often tobacco users, and had more primary care physician (PCP) visits. The most significant frequent ED use risk factors were a history of more than three hospital admissions in the previous 12 months (adj OR:23.2, 95%CI = 9.1-59.2), the absence of a PCP (adj OR:8.4, 95%CI = 2.1-32.7), living less than 5 km from an ED (adj OR:4.4, 95%CI = 2.1-9.0), and household income lower than USD 2,800/month (adj OR:4.3, 95%CI = 2.0-9.2). CONCLUSIONS: Frequent ED users within a universal health coverage system form a highly vulnerable population, when taking into account all five dimensions of a conceptual framework of vulnerability. The predictive factors identified could be useful in the early detection of future frequent users, in order to address their specific needs and decrease vulnerability, a key priority for health care policy makers. Application of the conceptual framework in future research is warranted.