Woodland Improvement and Crop Trees in Iowa, 2005

Vigorous and Healthy woodlands in Iowa have the unique distinction of being able to provide a wealth of benefits for the landowner and residents of the state. Benefits from a healthy forest include timber and wood resources, watershed protection, fragile site protection, wildlife and bird habitat, aesthetics and beauty, and recreational opportunities.

Improvement courses about violence prevention: the impact on health sector professionals

Uncontrolled intervention study that compared the effectiveness of two elective courses on Prevention and Assistance to violence victims for students and professionals of the Health Sector. The participants answered multiple-choice questions on the topic before and after the course. Statistical analyzes were performed by comparison of two proportions on STATA/IC. Regarding the overall index of correct answers,before and after, it was 54.8 and 58.4% in the 10h Course and the 69.6 and 79.2% in the 30h Course. The most effective course was the 30h Course, with strategies of case discussions and visits to assistance services to violence victims. There is a great necessity to include the discipline in the curriculum of healthcare courses permanently.



Rapid Improvement in Health-Related Quality of Life in Gouty Arthritis Patients Treated with Canakinumab (ACZ885) Compared to Triamcinolone Acetonide

Background: Gout patients initiating urate lowering therapy have an increased risk of flares. Inflammation in gouty arthritis is induced by interleukin (IL)-1b. Canakinumab inhibits IL-1b effectively in clinical studies. This study compared different doses of canakinumab vs colchicine in preventing flares in gout patients initiating allopurinol therapy.Methods: In this 24 wk double blind study, gout patients (20-79 years) initiating allopurinol were randomized (1:1:1:1:1:1:2) to canakinumab s.c. single doses of 25, 50, 100, 200, 300 mg, or 150mg divided in doses every 4 wks (50þ50þ25þ25mg [q4wk]) or colchicine 0.5mg p.o. daily for 16 wks. Primary outcome was to determine the canakinumab dose giving comparable efficacy to colchicine with respect to number of flares occurring during first 16 wks. Secondary outcomes included number of patients with flares and C-reactive protein (CRP) levels during the first 16 wks.Results: 432 patients were randomized and 391 (91%) completed the study. All canakinumab doses were better than colchicine in preventing flares and therefore, a canakinumab dose comparable to colchicine couldn't be determined. Based on a negative binomialmodel, all canakinumab groups, except 25 mg, reduced the flare rate ratio per patient significantly compared to colchicine group (rate ratio estimates 25mg 0.60, 50mg 0.34, 100mg 0.28, 200mg 0.37, 300mg 0.29, q4wk 0.38; p_0.05). Percentage of patients with flares was lower for all canakinumab groups (25mg 27.3%, 50mg 16.7%, 100mg 14.8%, 200mg 18.5%, 300mg 15.1%, q4wk 16.7%) compared to colchicine group (44.4%). All patients taking canakinumab were significantly less likely to experience at least one gout flare than patients taking colchicine (odds ratio range [0.22 - 0.47]; p_0.05 for all). Median baseline CRP levels were 2.86 mg/L for 25 mg, 3.42 mg/L for 50 mg, 1.76 mg/L for 100 mg, 3.66 mg/L for 200 mg, 3.21 mg/L for 300 mg, 3.23 mg/L for q4wk canakinumab groups and 2.69 mg/L for colchicine group. In all canakinumab groups with median CRP levels above the normal range at baseline, median levels declined within 15 days of treatment and were maintained at normal levels (ULN¼3 mg/L) throughout the 16 wk period. Adverse events (AEs) occurred in 52.7% (25 mg), 55.6% (50 mg), 51.9% (100 mg), 51.9% (200 mg), 54.7% (300 mg), 58.5% (q4wk) of patients on canakinumab vs 53.7% of patients on colchicine. Serious AEs (SAE) were reported in 2 (3.6%; 25 mg), 2 (3.7%, 50 mg), 3 (5.6%, 100 mg), 3 (5.6%, 200 mg), 3 (5.7%, 300 mg), 1 (1.9%, q4wk) patients on canakinumab and in 5 (4.6%) patients on colchicine. 1 fatal SAE (myocardial infarction, not related to study drug) occurred in colchicine group.Conclusions: In this randomized, double-blind active controlled study of flare prevention in gout patients initiating allopurinol therapy, treatment with canakinumab led to a statistically significant reduction in flares compared with colchicine and was well tolerated.Disclosure statement: U.A., A.B., G.K., D.R. and P.S. are employees of and have stock options or bold holdings with Novartis Pharma AG. E.M. is a principal investigator for Novartis Pharmaceuticals Corporation. E.N. has received consulting fees from Roche. N.S. has received research grants from Novartis Pharmaceuticals Corporation. A.S. has received consultancy fees from Novartis Pharma AG, Abbott, Bristol-Myers Squibb, Essex, Pfizer, MSD, Roche, UCB and Wyeth. All other authors have declared no conflicts of interest.

Pediatric patient classification system: improvement of an instrument

Objective Improve the content validity of the instrument for classification of pediatric patients and evaluate its construct validity. Method A descriptive exploratory study in the measurement of the content validity index, and correlational design for construct validation through exploratory factor analysis. Results The content validity index for indicators was 0.99 and it was 0.97 for graded situations. Three domains were extracted in the construct validation, namely: patient, family and therapeutic procedures, with 74.97% of explained variance. The instrument showed evidences of content and construct validity. Conclusion The validation of the instrument occurred under the approach of family-centered care, and allowed incorporating some essential needs of childhood such as playing, interaction and affection in the content of the instrument.


Watershed Improvement Review Board Calendar Year 2006 Annual Report, January 31, 2007

The Iowa Watershed Improvement Review Board (WIRB) was created by the Iowa Legislature and signed into law by the Governor in 2005 as Senate File 200. This statute is now codified in Iowa Code Chapter 466A. The fifteen-member Board conducted eight meetings throughout the year in-person or via teleconference. Meetings were held January 24, February 27, March 13, May 15, August 7, September 20, October 6, and December 18. Attachment 3 lists the board members and their organization affiliation. The Board appointed a five-member subcommittee to review and revise the Request For Applications (RFA) documents and submit recommendations to the full Board. The RFA documents were approved as modified at the May 15, 2006 Board meeting.

Epuration extrarénale continue pour l'insuffisance rénale aiguë aux soins intensifs [Continuous renal replacement therapy for acute kidney injury].

Acute kidney injury is common in critical illness and associated with important morbidity and mortality. Continuous renal replacement therapy (CRRT) enables physicians to safely and efficiently control associated metabolic and fluid balance disorders. The insertion of a large central venous catheter is required, which can be associated with mechanical and infectious complications. CRRT requires anticoagulation, which currently relies on heparin in most cases although citrate could become a standard in a near future. The choice of the substitution fluid depends on the clinical situation. A dose of 25 ml/kg/h is currently recommended.

Avaliação de necessidades de formação em professores do ensino secundário em Cabo Verde

II Resumo Cabo Verde é um país que tem acompanhado as grandes mudanças políticas, sociais, económicas e educativas, atribuindo um papel preponderante aos professores na educação/formação dos indivíduos. Neste sentido a formação inicial não pode constituir um acto “acabado” que não tem em linha de conta as mudanças que decorrem no seu seio. A formação contínua aparece com um processo de construção da mudança, apoiado no desenvolvimento profissional dos professores. A avaliação de necessidade de formação em professores do ensino secundário em Cabo Verde é o tema do trabalho de investigação, realizado nas escolas secundárias da ilha de Santo Antão, em Cabo Verde, no sentido de identificar questões problemáticas na formação inicial e contínua de professores e as suas implicações na qualidade educativa. Neste sentido, ao longo de 5 capítulos apresentamos os pontos desta investigação, estruturados de forma a se poder acompanhar a sua evolução. No 1º capítulo, apresenta-se a Problemática de Investigação, que constitui a parte inicial da dissertação, pela exposição do quadro conceptual do ensino secundário em Cabo Verde através da contextualização e identificação do problema, da formulação dos objectivos e questões de investigação. No 2º capítulo faz-se o percurso histórico/educativo de Cabo Verde, desde a época colonial, passando pela educação após a independência em 1975, à constituição da Lei de Bases do Sistema Educativo e a Reforma Educativa dos anos 90. No 3º capítulo, intitulado “A Formação Inicial e Continua de Professores em Cabo Verde”, é abordado o enquadramento teórico desta investigação, com referência à contextualização geral da formação e modelos de formação de professores, evoluindo para a realidade Cabo-verdiana, tendo em consideração as instituições de formação de professores e o contexto actual do ensino secundário em Cabo Verde. No 4º capítulo faz-se a apresentação da Metodologia de Investigação, adoptada num estudo extensivo, do qual abordamos a natureza da investigação e caracterizamos a amostra e respondentes. Como técnicas de recolha de dados, são utilizados: o inquérito por questionário (n=77), a professores do ensino secundário e o inquérito por entrevista (n=9), aos directores das escolas secundárias da ilha de Santo Antão e a formadores de professores em São Vicente. Como técnica de análise de dados, são utilizados diversos procedimentos estatísticos e a análise de conteúdo. O 5º capítulo corresponde a apresentação e discussão dos resultados da investigação desses três públicos analisados. Para finalizar, apresenta-se uma conclusão que corresponde a síntese dos resultados obtidos, propostas de sugestões de melhoria e limitações do estudo. Cabo Verde is a country willing to follow the great political, social, economic and educational changes. This important role have attributed to teachers to educate and train individuals. In this sense the initial training cannot be considered as a “finished” task without taking into consideration those changes. The in service training appears as a scientific and pedagogic autonomization towards the growing change. The Evaluation of Secondary School teacher training Needs in Cabo Verde constitutes an investigation work, carried out in Santo Antão's island Secondary schools, aiming to identify problems in initial and continuous teachers' training and their implications in the educational quality. In this sense, along five chapters we will present the points of this investigation, structured to facilitate the understanding of its evolution. In the first chapter we present the Problem of Investigation which is an introductory part of the dissertation, the conceptual theory of the Cabo Verde secondary education through the contextualization and identification of the problem, the formulation of the objectives and investigation issues. In the second chapter we present the Cabo Verde historical/educational background, from the colonial time, going through after independence in 1975, to the constitution of the Basic Educational Law of the System and the nineties Educational Reform. In the third chapter entitled “The Initial and in-service Teacher´s Training in Cabo Verde” brings the theoretical framework of this investigation, where we present a general contextualization of teachers' training and models, developed from the reality of Cabo Verde. In this regard we will consider the teachers' training institutions and the current secondary education context in Cabo Verde. In the fourth chapter we present the Research Methodology, adopted in an extensive study, of which we draw the nature of the investigation and we characterized the sample. We carried out questionnaire (n=77) to teachers, interviews (n=9) to headmasters from Santo Antão's island secondary schools and trainers from São Vicente. We used statistical analyses and content analyses as data analyse techniques. The fifth chapter deals with presentation the discussion of results of those three analyzed publics' investigation. Finally, we present a summary of the obtained results, suggestions for improvement and limitations of study.

Managers' perspective on continuous health education in a region of São Paulo State

OBJECTIVEAnalysing the concepts of Continuous Health Education - CHE (EPS - in Portuguese), operated by municipal managers and translated into official documents.METHODQualitative research with the use of official documents and semi-structured interviews with the Municipal Health Secretaries or Coordinators of Primary Health Care in the Northeast Region of São Paulo State, and thematic analysis of empirical material.RESULTSResults indicate difficulties in the municipalities problematizing their management practices, services and health care; EPS tools presented are insufficient and unsatisfactory for amending the array of problems raised and are still far from the routine of Primary Care services.CONCLUSIONDespite efforts to implement EPS actions for the strengthening of primary care, the process appears to be incipient.

Audit report on Mid-Iowa School Improvement Consortium, Carlisle, Iowa for the year ended June 30, 2006

Audit report on Mid-Iowa School Improvement Consortium, Carlisle, Iowa for the year ended June 30, 2006

Development of nursing management competencies: guidelines for continuous education services

Abstract OBJECTIVE Developing continuing education guidelines for the development of nursing management competencies along with the members of the Center of Nursing Continuing Education of Parana. METHOD A qualitative research outlined by the action research method, with a sample consisting of 16 nurses. Data collection was carried out in three stages and data were analyzed according to the thematic analysis technique. RESULTS It was possible to discuss the demands and difficulties in developing nursing management competencies in hospital organizations and to collectively design a guideline. CONCLUSION The action research contributed to the production of knowledge, confirming the need and the importance of changing the educational processes and evaluations, based on methodologies and instruments for professional development in accordance with human resource policies and contemporary organizational policies.

Improvement of the specificity of cancer detection by autofluorescence imaging in the tracheo-bronchial tree using backscattered violet light.

BACKGROUND: Autofluorescence bronchoscopy (AFB) is a highly sensitive tool for the detection of early bronchial cancers. However, its specificity remains limited due to primarily false positive results induced by hyperplasia, metaplasia and inflammation. We have investigated the potential of blue-violet backscattered light to eliminate false positive results during AFB in a clinical pilot study. METHODS: The diagnostic autofluorescence endoscopy (DAFE) system was equipped with a variable band pass filter in the imaging detection path. The backscattering properties of normal and abnormal bronchial mucosae were assessed by computing the contrast between the two tissue types for blue-violet wavelengths ranging between 410 and 490 nm in 12 patients undergoing routine DAFE examination. In a second study including 6 patients we used a variable long pass (LP) filter to determine the spectral design of the emission filter dedicated to the detection of this blue-violet light with the DAFE system. RESULTS: (Pre-)neoplastic mucosa showed a clear wavelength dependence of the backscattering properties of blue-violet light while the reflectivity of normal, metaplastic and hyperplastic autofluorescence positive mucosa was wavelength independent. CONCLUSIONS: Our results showed that the detection of blue-violet light has the potential to reduce the number of false positive results in AFB. In addition we determined the spectral design of the emission filter dedicated to the detection of this blue-violet light with the DAFE system.

Fiscal Year 2008-2012 Iowa Transportation Improvement Program

This document was prepared by the Iowa Department of Transportation to inform Iowans of planned investments in the state's transportation system over the next five years.

Continuous electroencephalography in the medical intensive care unit.

OBJECTIVES: To examine predictors and the prognostic value of electrographic seizures (ESZs) and periodic epileptiform discharges (PEDs) in medical intensive care unit (MICU) patients without a primary acute neurologic condition. DESIGN: Retrospective study. SETTING: MICU in a university hospital. PATIENTS: A total of 201 consecutive patients admitted to the MICU between July 2004 and January 2007 without known acute neurologic injury and who underwent continuous electroencephalography monitoring (cEEG) for investigation of possible seizures or changes in mental status. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Median time from intensive care unit (ICU) admission to cEEG was 1 day (interquartile range 1-4). The majority of patients (60%) had sepsis as the primary admission diagnosis and 48% were comatose at the time of cEEG. Ten percent (n = 21) of patients had ESZs, 17% (n = 34) had PEDs, 5% (n = 10) had both, and 22% (n = 45) had either ESZs or PEDs. Seizures during cEEG were purely electrographic (no detectable clinical correlate) in the majority (67%) of patients. Patients with sepsis had a higher rate of ESZs or PEDs than those without sepsis (32% vs. 9%, p < 0.001). On multivariable analysis, sepsis at ICU admission was the only significant predictor of ESZs or PEDs (odds ratio 4.6, 95% confidence interval 1.9-12.7, p = 0.002). After controlling for age, coma, and organ dysfunction, the presence of ESZs or PEDs was associated with death or severe disability at hospital discharge (89% with ESZs or PEDs, vs. 39% if not; odds ratio 19.1, 95% confidence interval 6.3-74.6, p < 0.001). CONCLUSION: In this retrospective study of MICU patients monitored with cEEG, ESZs and PEDs were frequent, predominantly in patients with sepsis. Seizures were mainly nonconvulsive. Both seizures and periodic discharges were associated with poor outcome. Prospective studies are warranted to determine more precisely the frequency and clinical impact of nonconvulsive seizures and periodic discharges, particularly in septic patients.

Nocturnal hypoglycaemias in type 1 diabetic patients: what can we learn with continuous glucose monitoring?

AIM: In type 1 diabetic patients (T1DM), nocturnal hypoglycaemias (NH) are a serious complication of T1DM treatment; self-monitoring of blood glucose (SMBG) is recommended to detect them. However, the majority of NH remains undetected on an occasional SMBG done during the night. An alternative strategy is the Continuous glucose monitoring (CGMS), which retrospectively shows the glycaemic profile. The aims of this retrospective study were to evaluate the true incidence of NH in T1DM, the best SMBG time to predict NH, the relationship between morning hyperglycaemia and NH (Somogyi phenomenon) and the utility of CGMS to reduce NH. METHODS: Eighty-eight T1DM who underwent a CGMS exam were included. Indications for CGMS evaluation, hypoglycaemias and correlation with morning hyperglycaemias were recorded. The efficiency of CGMS to reduce the suspected NH was evaluated after 6-9 months. RESULTS: The prevalence of NH was 67% (32% of them unsuspected). A measured hypoglycaemia at bedtime (22-24 h) had a sensitivity of 37% to detect NH (OR=2.37, P=0.001), while a single measure < or =4 mmol/l at 3-hour had a sensitivity of 43% (OR=4.60, P<0.001). NH were not associated with morning hyperglycaemias but with morning hypoglycaemias (OR=3.95, P<0.001). After 6-9 months, suspicions of NH decreased from 60 to 14% (P<0.001). CONCLUSION: NH were highly prevalent and often undetected. SMBG at bedtime, which detected hypoglycaemia had sensitivity almost equal to that of 3-hour and should be preferred because it is easier to perform. Somogyi phenomenon was not observed. CGMS is useful to reduce the risk of NH in 75% of patients.