New diagnoses of dementia among older patients admitted to postacute care.

Objectives: To determine the prevalence of dementia and the proportion of undiagnosed dementia in elderly patients admitted to postacute care, and to identify patients' characteristics associated with undiagnosed dementia. Design: Cross-sectional study. Setting: Academic postacute rehabilitation facility in Lausanne, Switzerland. Participants: Patients (N = 1764) aged 70 years and older. Measurements: Data on socio-demographic, medical, functional, and affective status were collected upon admission. Data on cognitive performance (Mini-Mental State Exam [MMSE]), and cognition-related discharge diagnoses were abstracted through a structured review of discharge summaries. Results: Overall, 24.1% (425/1764) patients had a diagnosis of dementia, most frequently secondary to Alzheimer's disease (260/425, 61.2%). Among dementia cases, 70.8% (301/425) were newly diagnosed during postacute stay. This proportion was lower among patients referred from internal medicine than from orthopedic/surgery services (65.8% versus 74.8%, P = .042). Compared to patients with already diagnosed dementia, those newly diagnosed were older, lived alone more frequently, and had better functional status and MMSE score at admission (all P < .05). In multivariate analysis, previously undetected dementia remained associated with older age (OR = 2.4 for age 85 years and older, 95% CI 1.5-4.0, P = .001) and normal MMSE at admission (OR = 5.9, 95% CI 2.7-12.7, P < .001). Conclusion: Dementia was present in almost a fourth of elderly patients referred to postacute care, but was diagnosed in less than a third before admission. Oldest old patients appear especially at risk for underrecognition. These results emphasize the high diagnostic yield of systematic cognitive assessment in the postacute care setting to improve these patients' management and quality of life.

Collaborative quality improvement to manage pain in acute care hospitals.

Objective. Collaborative quality improvement programs have been successfully used to manage chronic diseases in adults and acute lung complications in premature infants. Their effectiveness to improve pain management in acute care hospitals is currently unknown. The purpose of this study was to determine whether a collaborative quality improvement program implemented at hospital level could improve pain management and overall pain relief. Design.To assess the effectiveness of the program, we performed a before-after trial comparing patient's self-reported pain management and experience before and after program implementation. We included all adult patients hospitalized for more than 24 hours and discharged either to their home or to a nursing facility, between March 1, 2001 and March 31, 2001 (before program implementation) and between September 15, 2005 and October 15, 2005 (after program implementation). Setting.A teaching hospital of 2,096 beds in Geneva, Switzerland. Patients.All adult patients hospitalized for more than 24 hours and discharged between 1 to 31 March 2001 (before program) and 15 September to 15 October 2005 (after program implementation). Interventions.Implementation of a collaborative quality improvement program using multifaceted interventions (staff education, opinion leaders, patient education, audit, and feedback) to improve pain management at hospital level. Outcome Measures.Patient-reported pain experience, pain management, and overall hospital experience based on the Picker Patient Experience questionnaire, perceived health (SF-36 Health survey). Results.After implementation of the program only 2.3% of the patients reported having no pain relief during their hospital stay (vs 4.5% in 2001, P = 0.05). Among nonsurgical patients, improvements were observed for pain assessment (42.3% vs 27.9% of the patients had pain intensity measured with a visual analog scale, P = 0.012), pain management (staff did everything they could to help in 78.9% vs 67.9% of cases P = 0.003), and pain relief (70.4% vs 57.3% of patients reported full pain relief P = 0.008). In surgical patients, pain assessment also improved (53.7.3% vs 37.6%) as well as pain treatment. More patients received treatments to relieve pain regularly or intermittently after program implementation (95.1% vs 91.9% P = 0.046). Conclusion.Implementation of a collaborative quality improvement program at hospital level improved both pain management and pain relief in patients. Further studies are needed to determine the overall cost-effectiveness of such programs.

Report on Rest Area Water Systems for Interstate Highways, 1967

Introduction: As part of the roadside development along the Interstate Highway System, the Iowa State Highway Commission has constructed eight pair of rest area facilities. Furthermore, two pair are presently under construction with an additional two pair proposed for letting in 1967. An additional nine and one-half pairs of rest areas are in the planning phase, a grand total of 45 rest Brea buildings. The facilities existing were planned and designed in a relatively short period of time. The rest area facilities are unusual in terms of water use, water demand rates, and the fact that there are no applicable guidelines from previous installations. Such facilities are a pioneering effort to furnish a service -which the travelling public desires and will use. The acceptance and current use of the existing facilities shows that the rest areas do provide a service the public will use and appreciate. The Iowa State Highway Commission is to be congratulated for this· pioneering effort. However there are problems, as should be expected when design of a new type of facility has no past operating experience to use as a guide. Another factor which enters is that a rest area facility is quite different and rather unrelated to engineering in the highway field of practice. Basically, the problems encountered can be resolved into several areas, namely 1) maintenance problems in equipment due to 2) insufficient capacity of several other elements of the water systems, and 3) no provisions for water quality control. This study and report is supposed to essentially cover the review of the rest areas, either existing and under construction or letting. However, the approach used has been somewhat different. Several basic economically feasible water system schemes have been developed which are· adaptable to the different well capacities and different water qualities encountered. These basic designs are used as a guide in recommending modifications to the existing rest area water systems, anticipating that the basic designs will be used for future facilities. The magnitude of the problems involved is shown by the fact that the projected water use and demand variations of each rest area building is equivalent to the water supply for a community of about 100 people. The problems of proper operation and maintenance of an eventual thirty to forty-five such facilities are gigantic. For successful operation the rest area water systems must have a high degree of standardization and interchangeability of all elements of the water systems, even if it means a limited degree of over-design in some rest area facilities.

Predictors of functional recovery in patients admitted to geriatric postacute rehabilitation.

OBJECTIVE: To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation. DESIGN: Observational study. SETTING: Postacute rehabilitation facility. PARTICIPANTS: Patients (N=2754) aged ≥65 years admitted over a 4-year period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement. RESULTS: Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16-1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01-1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31-1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15-1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19-23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13-2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67-2.93; P<.001, respectively). CONCLUSIONS: Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome.

Monte Carlo simulation of a clearance box monitor used for nuclear power plant decommissioning.

When decommissioning a nuclear facility it is important to be able to estimate activity levels of potentially radioactive samples and compare with clearance values defined by regulatory authorities. This paper presents a method of calibrating a clearance box monitor based on practical experimental measurements and Monte Carlo simulations. Adjusting the simulation for experimental data obtained using a simple point source permits the computation of absolute calibration factors for more complex geometries with an accuracy of a bit more than 20%. The uncertainty of the calibration factor can be improved to about 10% when the simulation is used relatively, in direct comparison with a measurement performed in the same geometry but with another nuclide. The simulation can also be used to validate the experimental calibration procedure when the sample is supposed to be homogeneous but the calibration factor is derived from a plate phantom. For more realistic geometries, like a small gravel dumpster, Monte Carlo simulation shows that the calibration factor obtained with a larger homogeneous phantom is correct within about 20%, if sample density is taken as the influencing parameter. Finally, simulation can be used to estimate the effect of a contamination hotspot. The research supporting this paper shows that activity could be largely underestimated in the event of a centrally-located hotspot and overestimated for a peripherally-located hotspot if the sample is assumed to be homogeneously contaminated. This demonstrates the usefulness of being able to complement experimental methods with Monte Carlo simulations in order to estimate calibration factors that cannot be directly measured because of a lack of available material or specific geometries.

Mississippi Drive (Iowa 92) from Main Street to the Norbert F. Beckey Bridge in Muscatine, Iowa, STP-U-5330(614)—27-70, Muscatine County, 2015

The proposed action consists of upgrading Mississippi Drive (Iowa Highway 92) through downtown Muscatine, Iowa. The Mississippi Drive Corridor Project begins south of the Main Street/Grandview Avenue intersection, continuing to the East 2nd Street/Norbert F. Beckey Bridge intersection, which marks the end of the project. It passes through a mix of commercial, residential, Central Business District and industrial land uses. The total length of the project is approximately 1.6 miles, including 19 intersections (6 with traffic signals). Refer to the vicinity map on Figure 1. The current roadway is a 3- to 4-lane, urban facility with both divided and undivided medians. The roadway, ranging from 40 to 64 feet wide, is considered difficult to cross for pedestrians, especially for small children or elderly. The width of this roadway is being considered to be narrowed to improve the accessibility to the downtown from the Mississippi River riverfront area by pedestrians. This project also includes accommodations for bicycles and pedestrians and measures to reduce flooding on the roadway.

1102-001 Twelve Mile Lake Final Report

Twelve-Mile Lake is an 800-acre man-made lake in central Union County. The watershed has 13,964 land acres that are used by farmers for row crops and pasture. This lake is used as a water supply source for the City of Creston and the Southern Iowa Rural Water Association. In total approximately 40,000 people are affected by this project. Developed over 20 years ago, the lake and fishery was renovated and restocked and much of the shoreline was riprapped about six years ago. During its history, extensive watershed efforts have been ongoing. However, as farmland for cropland has become more valuable and demand has increased, hilly land once used for dairy farming, grazing, and CRP has been put into row crop production. Consequently, sediment loss has become an increasing issue for farmers, conservation professionals, and the Creston Waterworks Department, which owns the water treatment facility at the lake. In 2011, the Creston Water Board received a WIRB grant to implement a sedimentation structure at the north end of the main channel flowing into the lake. The WIRB funds were used for land acquisition, with the IDNR actually constructing the facility. This report depicts work performed as part of the WIRB project.

Health consultation : Sub-Slab Gas and Air Sampling Data Alcoa – Davenport Works CERCLIS No. IAD005270160 Riverdale, Scott County, Iowa (2005)

The U.S. Environmental Protection Agency (EPA), the Alcoa – Davenport Works Facility (Alcoa), and concerned citizens and community leaders of Riverdale, Iowa requested the Iowa Department of Public Health (IDPH) Hazardous Waste Site Health Assessment Program to evaluate the health impacts of exposures to volatile organic vapors detected within residences located immediately to the west of the Alcoa property. This health consultation addresses inhalation exposure to individuals that may have occupied the currently vacant residences in which the air sampling was completed.

Health consultation : Allied Products Corporation Targeted Brownfields Assessment 13th Avenue and E Street, Charles City, Floyd County, Iowa (2005)

The Iowa Department of Natural Resources (IDNR) has requested the Iowa Department of Public Health (IDPH) Hazardous Waste Site Health Assessment Program to evaluate environmental data collected at former farm equipment manufacturing facility located in Charles City, Iowa. The site, most recently operated by Allied Products Corporation, is a 70-acre site located at 13th Street and E Street in Charles City, Iowa (Figure 1). The site is undergoing a Targeted Brownfields Assessment conducted by the Contaminated Sites Section of the IDNR. This health consultation addresses potential health risks to people from future exposure to the soil within the property boundary, and any health impacts resulting from contaminated groundwater beneath the site property. The information in this health consultation was current at the time of writing. Data that emerges later could alter this document’s conclusions and recommendations.

Health consultation : Exposure to fluff material from the Shine Brothers and noise concerns -- Spencer, Iowa (2011)

This letter has been prepared as a consultation to determine some potential health concerns raised by a resident of Spencer from exposure to wire shredder fluff material emitted by Shine Brothers metal salvaging facility in Spencer, Iowa on July 10, 2011 and, a concern regarding the health impacts from the level of noise measured by a resident near the metal salvaging facility.

06027-013 Leisure Lake Watershed Final Report

Leisure Lake is approximately a 67 acre water body located in northwest Jackson County with a 2,681 acre drainage area. The watershed including the lake is a tributary to Lytle Creek which drains into the North Fork of the Maquoketa River. Portions of the Lytle Creek and North Fork Maquoketa River are on the 303(d) impaired waterbodies list. The project area includes a community of 370 residential properties and one business that currently has no central wastewater collection and treatment system. The purpose of this project is to construct a wastewater collection and treatment facility to improve water quality in the creek and river. The project will eliminate the non-permitted septic systems and construct a new wastewater system to properly treat wastewater prior to its discharge into the waterways.

07011-003 Keg Creek Watershed Final Report

Mills County proposes to reduce the identified impairment of the watershed, Keg Creek, by eliminating one of the main reasons for the impairment - non-conforming, on-site septic tanks that allow effluent to drain into the creek from the unincorporated community of Mineola. This has been identified by the county as a major priority. Therefore, the county proposes to construct a collection system and lagoon treatment facility, which would eliminate effluent from draining into Keg Creek. Regional Water will own, operate, and manage the collection and treatment systems in Mineola for Mills County.

LONG-TERM CARE Ombudsman, November 2014

Through advocacy, self-empowerment, and education by the Long-Term Care Ombudsman Program, each resident or tenant in a long-term care facility will be treated with dignity and respect and will have his or her rights honored.

Partnership for fragility bone fracture care provision and prevention program (P4Bones): study protocol for a secondary fracture prevention pragmatic controlled trial.

ABSTRACT: BACKGROUND: Fractures associated with bone fragility in older adults signal the potential for secondary fracture. Fragility fractures often precipitate further decline in health and loss of mobility, with high associated costs for patients, families, society and the healthcare system. Promptly initiating a coordinated, comprehensive pharmacological bone health and falls prevention program post-fracture may improve osteoporosis treatment compliance; and reduce rates of falls and secondary fractures, and associated morbidity, mortality and costs.Methods/design: This pragmatic, controlled trial at 11 hospital sites in eight regions in Quebec, Canada, will recruit community-dwelling patients over age 50 who have sustained a fragility fracture to an intervention coordinated program or to standard care, according to the site. Site study coordinators will identify and recruit 1,596 participants for each study arm. Coordinators at intervention sites will facilitate continuity of care for bone health, and arrange fall prevention programs including physical exercise. The intervention teams include medical bone specialists, primary care physicians, pharmacists, nurses, rehabilitation clinicians, and community program organizers.The primary outcome of this study is the incidence of secondary fragility fractures within an 18-month follow-up period. Secondary outcomes include initiation and compliance with bone health medication; time to first fall and number of clinically significant falls; fall-related hospitalization and mortality; physical activity; quality of life; fragility fracture-related costs; admission to a long term care facility; participants' perceptions of care integration, expectations and satisfaction with the program; and participants' compliance with the fall prevention program. Finally, professionals at intervention sites will participate in focus groups to identify barriers and facilitating factors for the integrated fragility fracture prevention program.This integrated program will facilitate knowledge translation and dissemination via the following: involvement of various collaborators during the development and set-up of the integrated program; distribution of pamphlets about osteoporosis and fall prevention strategies to primary care physicians in the intervention group and patients in the control group; participation in evaluation activities; and eventual dissemination of study results.Study/trial registration: Clinical Trial.Gov NCT01745068Study ID number: CIHR grant # 267395.

09014-010 Lytle Creek Watershed Final Report

Brief Project Summary (no greater than this space allows): Leisure Lake is a 20 acre water body located in northwest Jackson County with a 2,581 acre drainage area. This portion of the Maquoketa Watershed including the lake is a tributary to Lytle Creek which drains into the North Fork Maquoketa River and into the Maquoketa Watershed. Portions of the Lytle Creek and North Fork Maquoketa River are on the 303(d) impaired waterbodies list. The project area includes a community of 370 residential properties and one business that currently has no central waste water collection and treatment system. The County Sanitarian estimates at least 225 of these properties do not have properly operating septic systems and ultimately drain their wastewater into the lake. The purpose of this project is to construct a wastewater collection and treatment facility to improve water quality in the creek and river. The project will eliminate the non-permitted septic systems and construct a new wastewater system to properly treat wastewater prior to its discharge into the waterways.