Audit report of Iowa State University of Science and Technology, Ames, Iowa, and its discretely presented component unit as of and for the years ended June 30, 2013 and 2012

Audit report of Iowa State University of Science and Technology, Ames, Iowa, and its discretely presented component unit as of and for the years ended June 30, 2013 and 2012

Hypercalcaemia and acute renal failure after major burns: An under-diagnosed condition.

BACKGROUND: Hypercalcaemia has been shown to occur in about 20% of patients with major burns requiring prolonged intensive care unit (ICU) treatment, and it may be associated with renal failure. Having observed the early onset of hypercalcaemia, the study aimed to determine the frequency and timing of this condition in a European patient cohort. METHODS: A retrospective cohort study on a prospectively collected, computerised database of the 225 burn-injury ICU admissions between 2001 and 2007 was undertaken. The inclusion criteria included: burns >20% of the body surface area (BSA) or in-hospital stay >20 days. Hypercalcaemia was defined as an ionised plasma calcium (Ca(2+)) concentration >1.32 mmol l(-1) (or total corrected calcium=[Ca]c>2.55 mmol l(-1)). Four emblematic cases are reported in this article. RESULTS: A total of 73 patients met the inclusion criteria (age: 13-88 years, burns: 12-85% BSA): of these, 22 (30%) developed hypercalcaemia. The median time to the first hypercalcaemia value was 21 days. Only 11 patients had both high Ca(2+) and elevated [Ca]c (which remained normal in others). The risk factors of the disorder were burned surface (p=0.017) and immobilisation (fluidised bed use: p<0.05, duration: p=0.02) followed by burned BSA. Acute renal failure tended to be more frequent in hypercalcaemic patients (five (23%) vs. three (6%): p=0.11), while mortality was not increased. The disorder resolved with hydration and mobilisation in most cases: pamidronate was successful in three cases that were most severe. CONCLUSION: Hypercalcaemia and associated acute renal failure occur more frequently and earlier than previously reported. Determining the ionised Ca rather than the total Ca with albumin correction enables earlier detection of hypercalcaemia. Bisphosphonates are an effective treatment option in controlling severe hypercalcaemia and preventing bone loss.

The Value of the County Engineer: Strategies to Expand the Shrinking Employment Pool, HR-338, 1993

The first phase of this research involved an effort to identify the issues relevant to gaining a better understanding of the County Engineering profession. A related objective was to develop strategies to attract responsible, motivated and committed professionals to pursue County Engineering positions. In an era where a large percentage of County Engineers are reaching retirement age, the shrinking employment pool may eventually jeopardize the quality of secondary road systems not only in Iowa, but nationwide. As we move toward the 21st century, in an era of declining resources, it is likely that professional staff members in charge of secondary roads will find themselves working with less flexible budgets for the construction and maintenance of roads and bridges. It was important to understand the challenges presented to them, and the degree to which those challenges will demand greater expertise in prioritizing resource allocations for the rehabilitation and maintenance of the 10 million miles of county roads nationwide. Only after understanding what a county engineer is and what this person does will it become feasible for the profession to begin "selling itself", i.e., attracting a new generation of County Engineers. Reaching this objective involved examining the responsibilities, goals, and, sometimes, the frustrations experienced by those persons in charge of secondary road systems in the nine states that agreed to participate in the study. The second phase of this research involved addressing ways to counter the problems associated with the exodus of County Engineers who are reaching retirement age. Many of the questions asked of participants asked them to compare the advantages and disadvantages of public sector work with the private sector. Based on interviews with nearly 50 County Engineers and feedback from 268 who returned surveys for the research, issues relevant to the profession were analyzed and recommendations were made to the profession as it prepares to attract a new generation. It was concluded that both State and Regional Associations for County Engineers, and the National Association of County Engineers are most well-situated to present opportunities for continued professional development. This factor is appealing for those who are interested in competitive advantages as professionals. While salaries in the public sector may not be able to effectively compete with those offered by the private sector, it was concluded that this is only one factor of concern to those who are in the business of "public service". It was concluded, however, that Boards of Supervisors and their equivalents in other states will need to more clearly understand the value of the contributions made by County Engineers. Then the selling points the profession can hope to capitalize on can focus on the strength of state organizations and a strong national organization that act as clearinghouses of information and advocates for the profession, as well as anchors that provide opportunities for staying current on issues and technologies.

Clinical trial substantiates the predictive value of O-6-methylguanine-DNA methyltransferase promoter methylation in glioblastoma patients treated with temozolomide.

PURPOSE: In the setting of a prospective clinical trial, we determined the predictive value of the methylation status of the O-6-methylguanine-DNA methyltransferase (MGMT) promoter for outcome in glioblastoma patients treated with the alkylating agent temozolomide. Expression of this excision repair enzyme has been associated with resistance to alkylating chemotherapy. EXPERIMENTAL DESIGN: The methylation status of MGMT in the tumor biopsies was evaluated in 38 patients undergoing resection for newly diagnosed glioblastoma and enrolled in a Phase II trial testing concomitant and adjuvant temozolomide and radiation. The epigenetic silencing of the MGMT gene was determined using methylation-specific PCR. RESULTS: Inactivation of the MGMT gene by promoter methylation was associated with longer survival (P = 0.0051; Log-rank test). At 18 months, survival was 62% (16 of 26) for patients testing positive for a methylated MGMT promoter but reached only 8% (1 of 12) in absence of methylation (P = 0.002; Fisher's exact test). In the presence of other clinically relevant factors, methylation of the MGMT promoter remains the only significant predictor (P = 0.017; Cox regression). CONCLUSIONS: This prospective clinical trial identifies MGMT-methylation status as an independent predictor for glioblastoma patients treated with a methylating agent. The association of the epigenetic inactivation of the DNA repair gene MGMT with better outcome in this homogenous cohort may have important implications for the design of future trials and supports efforts to deplete MGMT by O-6-benzylguanine, a noncytotoxic substrate of this enzyme.

La politique régionale : entre compétitivité et respect de l'environnement

Aujourd'hui plus que jamais, le développement économique ne peut se faire au détriment de notre environnement naturel. Dès lors se pose la question de savoir comment parvenir à maintenir la compétitivité d'une économie, tout en tenant compte de l'impact qu'elle a sur révolution du cadre naturel. La présente recherche propose d'investiguer sur la question en se penchant sur les politiques publiques de promotion économique, et plus spécifiquement sur la politique régionale. Faut-il maintenir la confiance dans les courants néoclassiques, comme le laisse supposer la situation actuelle, renforcer la position d'une économie s'inscrivant au sein d'un cadre socio-environnemental ou encore repenser notre mode de fonctionnement économique quant à son développement ? Dans le cas présent, la politique régionale suisse est évaluée à la lumière de trois stratégies de développement économique. D'une part, il y a l'économie fondée sur la connaissance. Cette dernière est à la base de la philosophie actuelle en matière de politique régionale. Ensuite, il y a l'écologie industrielle, qui pour sa part fait la promesse d'un développement économique éco-compatible. Enfin, la troisième stratégie est celle de l'économie de fonctionnalité, qui propose de maximiser l'efficience d'une unité de matière première en limitant notamment la notion de propriété. Au travers d'une grille d'analyse construite sur le modèle des géographies de la grandeur, les trois stratégies sont confrontées aux objectifs de la nouvelle politique régionale suisse (NPR) ainsi qu'à ses modalités de mise en oeuvre. Il en ressort qu'en l'état actuel, la stratégie misant sur l'économie de la connaissance est la plus à même de relever le défi d'un développement économique durable. Toutefois, moyennant adaptations, les autres stratégies pourraient également se révéler être pertinentes. On constate notamment que les éléments clés sont ici l'innovation, ainsi que les dimensions spatiale et temporelle des stratégies. Nous recommandons dès lors d'adopter une approche territorialisée du développement économique, selon une logique de projet au sens de Boltanski & Chiapello. A notre sens, seules les propositions à même de fédérer les acteurs et disposant d'une vision intégrée du développement ont une chance de permettre un développement économique en harmonie avec notre cadre environnemental. - Today more than ever, economic development can't go ahead without consideration for our natural environment. This lays us with the question of how to maintain the competitiveness of an economy, and at the same time to manage the impact of it on the natural frame. This research aims to investigate this question through public policies fostering economy, more specifically through the regional policy. Must one trust the neo-classical way, as the actual situation let's think about it, reinforce the position of an economy within a socio- environmental frame or moreover reinvent our economical modus regarding development? In this case, an assessment of the Swiss regional policy is lead through three strategies of economic development. First, there is the knowledge economy. It is the core concept of the actual philosophy regarding regional policy. Second, there is the industrial ecology which aims to promote an eco-compatible economic development. Last, there is the functional economy, which proposes to maximize the efficiency of every used unit of natural resources by limiting in particular the notion of propriety. Through an analytic frame built on the model of geographies of greatness (géographies de la grandeuή, the three strategies are confronted to the objectives of the Swiss new regional policy (NRP) as well as its implementation. It turns out that actually, the strategy laying on the knowledge economy happens to be the best solution in order to promote a sustainable economic development. Nevertheless, with few adaptations, the other strategies could be pregnant as well. What we can see is that key- elements are here the innovation, as well as the spatial and temporal dimensions of these strategies. We recommend therefore to adopt a territorialised approach of economic development, with a project-based logic as meant by Boltanski & Chiapello. We are convinced that only propositions which are able to unit actors, and with an integrated point of view, have a chance to promote economic development in harmony with our environmental frame.

Evaluation of the Video Intubation Unit in morbid obese patients.

BACKGROUND: Tracheal intubation may be more difficult in morbidly obese (MO) patients than in the non-obese. The aim of this study was to evaluate clinically if the use of the Video Intubation Unit (VIU), a video-optical intubation stylet, could improve the laryngoscopic view compared with the standard Macintosh laryngoscope in this specific population. METHODS: We studied 40 MO patients (body mass index >35 kg/m(2)) scheduled for bariatric surgery. Each patient had a conventional laryngoscopy and a VIU inspection. The laryngoscopic grades (LG) using the Cormack and Lehane scoring system were noted and compared. Thereafter, the patients were randomised to be intubated with one of the two techniques. In one group, the patients were intubated with the help of the VIU and in the control group, tracheal intubation was performed conventionally. The duration of intubation, as well as the minimal SpO(2) achieved during the procedure, were measured. RESULTS: Patient characteristics were similar in both groups. Seventeen patients had a direct LG of 2 or 3 (no patient had a grade of 4). Out of these 17 patients, the LG systematically improved with the VIU and always attained grade 1 (P<0.0001). The intubation time was shorter within the VIU group, but did not attain significance. There was no difference in the SpO(2) post-intubation. CONCLUSION: In MO patients, the use of the VIU significantly improves the visualisation of the larynx, thereby improving the intubation conditions.

Creating a list of low-value health care activities in Swiss primary care.

Trisomy 21 is the most frequent genetic cause of cognitive impairment. To assess the perturbations of gene expression in trisomy 21, and to eliminate the noise of genomic variability, we studied the transcriptome of fetal fibroblasts from a pair of monozygotic twins discordant for trisomy 21. Here we show that the differential expression between the twins is organized in domains along all chromosomes that are either upregulated or downregulated. These gene expression dysregulation domains (GEDDs) can be defined by the expression level of their gene content, and are well conserved in induced pluripotent stem cells derived from the twins' fibroblasts. Comparison of the transcriptome of the Ts65Dn mouse model of Down's syndrome and normal littermate mouse fibroblasts also showed GEDDs along the mouse chromosomes that were syntenic in human. The GEDDs correlate with the lamina-associated (LADs) and replication domains of mammalian cells. The overall position of LADs was not altered in trisomic cells; however, the H3K4me3 profile of the trisomic fibroblasts was modified and accurately followed the GEDD pattern. These results indicate that the nuclear compartments of trisomic cells undergo modifications of the chromatin environment influencing the overall transcriptome, and that GEDDs may therefore contribute to some trisomy 21 phenotypes.

Predictive value of readiness, importance, and confidence in ability to change drinking and smoking.

BACKGROUND: Visual analog scales (VAS) are sometimes used to assess change constructs that are often considered critical for change. Aims of Study: 1.) To determine the association of readiness to change, importance of changing and confidence in ability to change alcohol and tobacco use at baseline with the risk for drinking (more than 21 drinks per week/6 drinks or more on a single occasion more than once per month) and smoking (one or more cigarettes per day) six months later. 2.) To determine the association of readiness, importance and confidence with alcohol (number of drinks/week, number of binge drinking episodes/month) and tobacco (number of cigarettes/day) use at six months. METHODS: This is a secondary analysis of data from a multi-substance brief intervention randomized trial. A sample of 461 Swiss young men was analyzed as a prospective cohort. Participants were assessed at baseline and six months later on alcohol and tobacco use, and at baseline on readiness to change, importance of changing and confidence in ability to change constructs, using visual analog scales ranging from 1-10 for drinking and smoking behaviors. Regression models controlling for receipt of brief intervention were employed for each change construct. The lowest level (1-4) of each scale was the reference group that was compared to the medium (5-7) and high (8-10) levels. RESULTS: Among the 377 subjects reporting unhealthy alcohol use at baseline, mean (SD) readiness, importance and confidence to change drinking scores were 3.9 (3.0), 2.7 (2.2) and 7.2 (3.0), respectively. At follow-up, 108 (29%) reported no unhealthy alcohol use. Readiness was not associated with being risk-free at follow-up, but high importance (OR 2.94; 1.15, 7.50) and high confidence (OR 2.88; 1.46, 5.68) were. Among the 255 smokers at baseline, mean readiness, importance and confidence to change smoking scores were 4.6 (2.6), 5.3 (2.6) and 5.9 (2.7), respectively. At follow-up, 13% (33) reported no longer smoking. Neither readiness nor importance was associated with being a non-smoker, whereas high confidence (OR 3.29; 1.12, 9.62) was. CONCLUSIONS: High confidence in ability to change was associated with favorable outcomes for both drinking and smoking, whereas high importance was associated only with a favorable drinking outcome. This study points to the value of confidence as an important predictor of successful change for both drinking and smoking, and shows the value of importance in predicting successful changes in alcohol use. TRIAL REGISTRATION NUMBER: ISRCTN78822107.

Improved multiple-locus variable-number tandem-repeat assay for Staphylococcus aureus genotyping, providing a highly informative technique together with strong phylogenetic value.

We describe an improved multiple-locus variable-number tandem-repeat (VNTR) analysis (MLVA) scheme for genotyping Staphylococcus aureus. We compare its performance to those of multilocus sequence typing (MLST) and spa typing in a survey of 309 strains. This collection includes 87 epidemic methicillin-resistant S. aureus (MRSA) strains of the Harmony collection, 75 clinical strains representing the major MLST clonal complexes (CCs) (50 methicillin-sensitive S. aureus [MSSA] and 25 MRSA), 135 nasal carriage strains (133 MSSA and 2 MRSA), and 13 published S. aureus genome sequences. The results show excellent concordance between the techniques' results and demonstrate that the discriminatory power of MLVA is higher than those of both MLST and spa typing. Two hundred forty-two genotypes are discriminated with 14 VNTR loci (diversity index, 0.9965; 95% confidence interval, 0.9947 to 0.9984). Using a cutoff value of 45%, 21 clusters are observed, corresponding to the CCs previously defined by MLST. The variability of the different tandem repeats allows epidemiological studies, as well as follow-up of the evolution of CCs and the identification of potential ancestors. The 14 loci can conveniently be analyzed in two steps, based upon a first-line simplified assay comprising a subset of 10 loci (panel 1) and a second subset of 4 loci (panel 2) that provides higher resolution when needed. In conclusion, the MLVA scheme proposed here, in combination with available on-line genotyping databases (including http://mlva.u-psud.fr/), multiplexing, and automatic sizing, can provide a basis for almost-real-time large-scale population monitoring of S. aureus.

Expérience de dix ans de réanimation chirurgicale d'un centre hospitalier universitaire. Détermination d'un critère d'identification des patients à risque de décéder de coagulopathie irréversible [10 years experience in surgical resuscitation at a university hospital center. Determination of a criterion for identifying patients at risk for fatal irreversible coagulopathy]

The authors evaluated ten years of surgical reanimation in the University Centre of Lausanne (CHUV). Irreversible coagulopathy (IC) is the predominant cause of death for the polytraumatized patient. Acidosis, hypothermy, and coagulation troubles are crucial elements of this coagulopathy. The authors looked for a criterion allowing the identification of dying of IC. In a retrospective study, laboratory results of pH, TP, PTT, thrombocyte count and the need for blood transfusion units were checked for each major step of the primary evaluation and treatment of the polytraumatized patients. These results were considered as critical according to criteria of the literature (30). The authors conclude that the apparation of a third critical value may be useful to identify the polytraumatized patient at risk of dying of IC status. This criterion may also guide the trauma team in selecting a damage control surgical approach (DCS). This criterion was then introduced into an algorithm involving the Emergency Department, the operating room and the Intensive Care Unit. This criterion is a new tool to address the patient at the crucial moment to the appropriate hospital structure.

The habenula encodes negative motivational value associated with primary punishment in humans.

Learning what to approach, and what to avoid, involves assigning value to environmental cues that predict positive and negative events. Studies in animals indicate that the lateral habenula encodes the previously learned negative motivational value of stimuli. However, involvement of the habenula in dynamic trial-by-trial aversive learning has not been assessed, and the functional role of this structure in humans remains poorly characterized, in part, due to its small size. Using high-resolution functional neuroimaging and computational modeling of reinforcement learning, we demonstrate positive habenula responses to the dynamically changing values of cues signaling painful electric shocks, which predict behavioral suppression of responses to those cues across individuals. By contrast, negative habenula responses to monetary reward cue values predict behavioral invigoration. Our findings show that the habenula plays a key role in an online aversive learning system and in generating associated motivated behavior in humans.

Nd and Sr isotope compositions in modern and fossil bones - Proxies for vertebrate provenance and taphonomy

Rare earth elements (REE), while not essential for the physiologic functions of animals, are ingested and incorporated in ppb concentrations in bones and teeth. Nd isotope compositions of modern bones of animals from isotopically distinct habitats demonstrate that the (143)Nd/(144)Nd of the apatite can be used as a fingerprint for bedrock geology or ambient water mass. This potentially allows the provenance and migration of extant vertebrates to be traced, similar to the use of Sr isotopes. Although REE may be enriched by up to 5 orders of magnitude during diagenesis and recrystallization of bone apatite, in vivo (143)Nd/(144)Nd may be preserved in the inner cortex of fossil bones or enamel. However, tracking the provenance of ancient or extinct vertebrates is possible only for well-preserved archeological and paleontological skeletal remains with in vivo-like Nd contents at the ppb-level. Intra-bone and -tooth REE analysis can be used to screen for appropriate areas. Large intra-bone Nd concentration gradients of 10(1)-10(3) are often measured. Nd concentrations in the inner bone cortex increase over timescales of millions of years, while bone rims may be enriched over millenial timescales. Nevertheless, epsilon(Nd) values are often similar within one epsilon(Nd) unit within a single bone. Larger intra-bone differences in specimens may either reflect a partial preservation of in vivo values or changing epsilon(Nd) values of the diagenetic fluid during fossilization. However, most fossil specimens and the outer rims of bones will record taphonomic (143)Nd/(144)Nd incorporated post mortem during diagenesis. Unlike REE patterns, (143)Nd/(144)Nd are not biased by fractionation processes during REE-uptake into the apatite crystal lattice, hence the epsilon(Nd) value is an important tracer for taphonomy and reworking. Bones and teeth from autochthonous fossil assemblages have small variations of +/- 1 epsilon(Nd) unit only. In contrast, fossil bones and teeth from over 20 different marine and terrestrial fossil sites have a total range of epsilon(Nd) values from -13.0 to 4.9 (n = 80), often matching the composition of the embedding sediment. This implies that the surrounding sediment is the source of Nd in the fossil bones and that the specimens of this study seem not to have been reworked. Differences in epsilon(Nd) values between skeletal remains and embedding sediment may either indicate reworking of fossils and/or a REE-uptake from a diagenetic fluid with non-sediment derived epsilon(Nd) values. The latter often applies to fossil shark teeth, which may preserve paleo-seawater values. Complementary to epsilon(Nd) values, (87)Sr/(86)Sr can help to further constrain the fossil provenance and reworking. (C) 2011 Elsevier Ltd. All rights reserved.

Value of positron emission tomography in full-thickness chest wall resections for malignancies.

Preoperative imaging for resection of chest wall malignancies is generally performed by computed tomography (CT). We evaluated the role of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in planning full-thickness chest wall resections for malignancies. We retrospectively included 18 consecutive patients operated from 2004 to 2006 at our institution. Tumor extent was measured by CT and PET, using the two largest perpendicular tumor extensions in the chest wall plane to compute the tumor surface assuming an elliptical shape. Imaging measurements were compared to histopathology assessment of tumor borders. CT assessment consistently overestimated the tumor size as compared to PET (+64% vs. +1%, P<0.001). Moreover, PET was significantly better than CT at defining the size of lesions >24 cm(2) corresponding to a mean diameter >5.5 cm or an ellipse of >4 cm x 7.6 cm (positive predictive value 80% vs. 44% and specificity 93% vs. 64%, respectively). Metabolic PET imaging was superior to CT for defining the extent of chest wall tumors, particularly for tumors with a diameter >5.5 cm. PET can complement CT in planning full-thickness chest wall resection for malignancies, but its true value remains to be determined in larger, prospective studies.