Report on a special investigation of the Rodman Volunteer Fire Department and Park and Recreation Department for the period January 1, 2006 through September 30, 2009

Report on a special investigation of the Rodman Volunteer Fire Department and Park and Recreation Department for the period January 1, 2006 through September 30, 2009

Report on Aging Resources of Central Iowa for the period July 1, 2005 through June 30, 2009

Report on Aging Resources of Central Iowa for the period July 1, 2005 through June 30, 2009

Report on a special investigation of the City of New Albin for the period January 1, 2006 through July 31, 2009

Report on a special investigation of the City of New Albin for the period January 1, 2006 through July 31, 2009

Report on a special investigation of the Cedar Rapids Community School District for the period July 1, 2002 through August 24, 2009

Report on a special investigation of the Cedar Rapids Community School District for the period July 1, 2002 through August 24, 2009

Report on the IowaCare program administered by the Iowa Medicaid Enterprise, a division of the Department of Human Services (DHS-IME), for the period July 1, 2005 through June 30, 2009

Report on the IowaCare program administered by the Iowa Medicaid Enterprise, a division of the Department of Human Services (DHS-IME), for the period July 1, 2005 through June 30, 2009

Report on the City of Harper for the period July 1, 2008 through December 31, 2009

Report on the City of Harper for the period July 1, 2008 through December 31, 2009

Report on a review of selected general and application controls over the Iowa Department of Human Services’ Issuance Verification System for the period March 19, 2009 through April 17, 2009

Report on a review of selected general and application controls over the Iowa Department of Human Services’ Issuance Verification System for the period March 19, 2009 through April 17, 2009

Report on the City of Van Wert for the period July 1, 2008 through June 30, 2009

Report on the City of Van Wert for the period July 1, 2008 through June 30, 2009

Report on a special investigation of certain collections of the Tama County Clerk of Court and the Tama County Sheriff’s Office for the period January 1, 2007 through August 31, 2009

Report on a special investigation of certain collections of the Tama County Clerk of Court and the Tama County Sheriff’s Office for the period January 1, 2007 through August 31, 2009

Report on the Juvenile Detention Home Fund administered by the Department of Human Services for the period July 1, 2007 through November 10, 2009

Report on the Juvenile Detention Home Fund administered by the Department of Human Services for the period July 1, 2007 through November 10, 2009

Report on a special investigation of Squaw Township for the period April 19, 2001 through March 18, 2009

Report on a special investigation of Squaw Township for the period April 19, 2001 through March 18, 2009

Reaudit report on the City of Waverly, Iowa for the period July 1, 2007 through June 30, 2008

Reaudit report on the City of Waverly, Iowa for the period July 1, 2007 through June 30, 2008

A vaccine against nicotine for smoking cessation: a randomized controlled trial.

BACKGROUND: Tobacco dependence is the leading cause of preventable death and disabilities worldwide and nicotine is the main substance responsible for the addiction to tobacco. A vaccine against nicotine was tested in a 6-month randomized, double blind phase II smoking cessation study in 341 smokers with a subsequent 6-month follow-up period. METHODOLOGY/PRINCIPAL FINDINGS: 229 subjects were randomized to receive five intramuscular injections of the nicotine vaccine and 112 to receive placebo at monthly intervals. All subjects received individual behavioral smoking cessation counseling. The vaccine was safe, generally well tolerated and highly immunogenic, inducing a 100% antibody responder rate after the first injection. Point prevalence of abstinence at month 2 showed a statistically significant difference between subjects treated with Nicotine-Qbeta (47.2%) and placebo (35.1%) (P = 0.036), but continuous abstinence between months 2 and 6 was not significantly different. However, in subgroup analysis of the per-protocol population, the third of subjects with highest antibody levels showed higher continuous abstinence from month 2 until month 6 (56.6%) than placebo treated participants (31.3%) (OR 2.9; P = 0.004) while medium and low antibody levels did not increase abstinence rates. After 12 month, the difference in continuous abstinence rate between subjects on placebo and those with high antibody response was maintained (difference 20.2%, P = 0.012). CONCLUSIONS: Whereas Nicotine-Qbeta did not significantly increase continuous abstinence rates in the intention-to-treat population, subgroup analyses of the per-protocol population suggest that such a vaccination against nicotine can significantly increase continuous abstinence rates in smokers when sufficiently high antibody levels are achieved. Immunotherapy might open a new avenue to the treatment of nicotine addiction. TRIAL REGISTRATION: Swiss Medical Registry 2003DR2327; ClinicalTrials.gov NCT00369616.

Angiotensin-converting enzyme inhibition improves vascular function in rheumatoid arthritis.

BACKGROUND: The excess in cardiovascular risk in patients with rheumatoid arthritis provides a strong rationale for early therapeutical interventions. In view of the similarities between atherosclerosis and rheumatoid arthritis and the proven benefit of angiotensin-converting enzyme inhibitors in atherosclerotic vascular disease, it was the aim of the present study to delineate the impact of ramipril on endothelial function as well as on markers of inflammation and oxidative stress in patients with rheumatoid arthritis. METHODS AND RESULTS: Eleven patients with rheumatoid arthritis were included in this randomized, double-blind, crossover study to receive ramipril in an uptitration design (2.5 to 10 mg) for 8 weeks followed by placebo, or vice versa, on top of standard antiinflammatory therapy. Endothelial function assessed by flow-mediated dilation of the brachial artery, markers of inflammation and oxidative stress, and disease activity were investigated at baseline and after each treatment period. Endothelial function assessed by flow-mediated dilation increased from 2.85+/-1.49% to 4.00+/-1.81% (P=0.017) after 8 weeks of therapy with ramipril but did not change with placebo (from 2.85+/-1.49% to 2.84+/-2.47%; P=0.88). Although systolic blood pressure and heart rate remained unaltered, diastolic blood pressure decreased slightly from 78+/-7 to 74+/-6 mm Hg (P=0.03). Tumor necrosis factor-alpha showed a significant inverse correlation with flow-mediated dilation (r=-0.408, P=0.02), and CD40 significantly decreased after ramipril therapy (P=0.049). CONCLUSIONS: Angiotensin-converting enzyme inhibition with 10 mg/d ramipril for 8 weeks on top of current antiinflammatory treatment markedly improved endothelial function in patients with rheumatoid arthritis. This finding suggests that angiotensin-converting enzyme inhibition may provide a novel strategy to prevent cardiovascular events in these patients.

Agreed upon procedures report on the City of Bevington, Iowa for the period July 1, 2008 through June 30, 2009

Agreed upon procedures report on the City of Bevington, Iowa for the period July 1, 2008 through June 30, 2009