Library Services System for Iowa Library Services Task Force Report, December 2000

As a guide for librarians, library policy makers and the local level, community leaders, local and state policy makers, and library customers across the state, these recommendations create a vision of libraries as friendly, welcoming places where Iowans can access inform ation in person or on-lin e, ob tain, an d use ideas and truste d info rmatio n tha t will enhance their quality of life. This report specifies the steps to achieving this vision and creates an environment of opportunity to m ove s teadily toward the new system.

Epidemiology of incident heart failure in a contemporary elderly cohort: the health, aging, and body composition study.

BACKGROUND: The race- and sex-specific epidemiology of incident heart failure (HF) among a contemporary elderly cohort are not well described. METHODS: We studied 2934 participants without HF enrolled in the Health, Aging, and Body Composition Study (mean [SD] age, 73.6 [2.9] years; 47.9% men; 58.6% white; and 41.4% black) and assessed the incidence of HF, population-attributable risk (PAR) of independent risk factors for HF, and outcomes of incident HF. RESULTS: During a median follow-up of 7.1 years, 258 participants (8.8%) developed HF (13.6 cases per 1000 person-years; 95% confidence interval, 12.1-15.4). Men and black participants were more likely to develop HF. No significant sex-based differences were observed in risk factors. Coronary heart disease (PAR, 23.9% for white participants and 29.5% for black participants) and uncontrolled blood pressure (PAR, 21.3% for white participants and 30.1% for black participants) carried the highest PAR in both races. Among black participants, 6 of 8 risk factors assessed (smoking, increased heart rate, coronary heart disease, left ventricular hypertrophy, uncontrolled blood pressure, and reduced glomerular filtration rate) had more than 5% higher PAR compared with that among white participants, leading to a higher overall proportion of HF attributable to modifiable risk factors in black participants vs white participants (67.8% vs 48.9%). Participants who developed HF had higher annual mortality (18.0% vs 2.7%). No racial difference in survival after HF was noted; however, rehospitalization rates were higher among black participants (62.1 vs 30.3 hospitalizations per 100 person-years, P < .001). CONCLUSIONS: Incident HF is common in older persons; a large proportion of HF risk is attributed to modifiable risk factors. Racial differences in risk factors for HF and in hospitalization rates after HF need to be considered in prevention and treatment efforts.

Medical and legal professionals' attitudes towards confidentiality and disclosure of clinical information in forensic settings: a survey using case vignettes.

OBJECTIVE: When potentially dangerous patients reveal criminal fantasies to their therapists, the latter must decide whether this information has to be transmitted to a third person in order to protect potential victims. We were interested in how medical and legal professionals handle such situations in the context of prison medicine and forensic evaluations. We aimed to explore the motives behind their actions and to compare these professional groups. METHOD: A mail survey was conducted among medical and legal professionals using five fictitious case vignettes. For each vignette, participants were asked to answer questions exploring what the professional should do in the situation and to explain their justification for the chosen response. RESULTS: A total of 147 questionnaires were analysed. Agreement between participants varied from one scenario to another. Overall, legal professionals tended to disclose information to a third party more easily than medical professionals, the latter tending to privilege confidentiality and patient autonomy over security. Perception of potential danger in a given situation was not consistently associated with actions. CONCLUSION: Professionals' opinions and attitudes regarding the confidentiality of potentially dangerous patients differ widely and appear to be subjectively determined. Shared discussions about clinical situations could enhance knowledge and competencies and reduce differences between professional groups.

Do youths gamble? You bet! A Swiss population-based study.

OBJECTIVES: To establish the gambling prevalence among Swiss resident youths, to estimate the associations between gambling frequency and substance use, poor mental health and social support and to determine the correlation between gambling pattern and gambling frequency. METHODS: Cross-sectional population-based survey conducted in 2007. From 1233 eligible participants aged 15-24 years, adequate information was available for 1116 (582 males), distributed into: non- (n=577), occasional (n=388) and frequent gamblers (n=151). Outcome measures: Substance use, social activities, presence of a reliable person among friends or family, psychological distress, major depression and gambling pattern. RESULTS: Overall, the 48.3% (n=539) of youths who had gambled during the previous year; were older and more likely to be male than non-gamblers. 13.5% (n=151) gambled at least weekly and could be differentiated from occasional gamblers on the basis of their gambling pattern. After controlling for gender, age and language area, occasional gamblers were significantly more likely to be occasional binge drinkers, whereas frequent gamblers were more likely to be daily smokers. CONCLUSION: Almost half of Swiss resident youths are involved in gambling. Both occasional and frequent gambling are associated with further health compromising behaviour. Practitioners dealing with young people should be aware that gambling is a behaviour that might be part of a more global risky behaviour framework.

Research involving biological material from forensic autopsies: legal and ethical issues.

Recommendations and laws do not always contain specific and clear provisions on the use of cadaveric material in research, and even more rarely do they address explicitly the ethical issues related to research on material obtained during forensic autopsy. In this article we analyse existing legal frameworks in Europe by comparing the legal provisions in 2 European Countries which are member states of the Council of Europe, the UK and Switzerland. They were chosen because they have distinct legal frameworks that make comparisons interesting. In addition, the detailed laws of the UK and a specific law project and national ethical recommendations in Switzerland permit us to define more clearly the legal range of options for researchers using cadaveric material obtained during forensic investigations. The Human Tissue Act 2004 in England, Wales and Northern Ireland, its Scottish equivalent with the same title (2006) and the national ethical guidelines in Switzerland all require consent from the deceased person, an appropriate relative or a person with power of attorney for healthcare decisions before cadaveric biological material can be obtained and used for research. However, if the purpose of the autopsy is purely forensic, no such authorization will be sought to carry out the autopsy and related analyses, which might include genetic testing. In order to be allowed to carry out future research projects, families need to be approached for informed consent, unless the deceased person had left written directives including permission to use his or her tissues for research.

Strategic Plan Iowa Workforce Development October, 2004

For the 2004 strategic planning process at Iowa Workforce Development, Director Richard Running asked for as much input from all staff as possible. As a result, planning staff designed an extensive process to gather input over about a three month period during the late spring and summer: • A Guide to Staff Involvement was drafted and distributed to staff in offices throughout the state. This guide provided a brief explanation of the planning process and quoted extensively from the Vilsack/Pederson Leadership Agenda and the 2003 IWD strategic plan to illustrate each step and to show examples of alignment. The guide also provided suggestions for staff in various locations and work units to conduct their own planning sessions. The structure was designed to solicit feedback regarding elements (vision, mission, guiding principles, goals and strategies) of the existing 2003 plan. Particular attention was devoted to securing non-management staff’s perspective during the internal and external assessment exercises. • Several local offices did conduct their own structured input sessions following the suggested guidelines and sent the results to planning staff in the central administrative offices. • Other work units in many locations opted to ask planning staff to facilitate planning sessions for them. The results of these sessions were also gathered by planning staff. In all, dozens of input sessions were held and hundreds of IWD staff participated directly in the process. Because all the sessions followed similar guidelines, it was relatively easy to combine all of the input received and spot common themes that surfaced from the many sessions. A composite of all the flip chart notes was compiled into one large document (for those who like lots of detail) and another document summarized the key themes that emerged. This information was used in a day-long planning retreat on August 20. Management staff members from throughout the department were invited and each work unit and sub-state region also brought a non-management staff person as well. This group reviewed the themes from the earlier sessions and then addressed each element of the 2003 plan, proposing refinements for almost all sections. Subsequently, senior management reviewed the results of the retreat and made the final decisions for the new 2004 plan. This thorough approach, with its special emphasis on input from line staff, did result in some significant changes to IWD’s plan. Local office staff, for example, consistently expressed the need to step up our marketing efforts, especially with employers. Another need that was expressed clearly and often was the need to beef up staff training efforts, much of the capacity for which had been lost in budget and staff reductions a few years ago. Neither of these issues is new, but the degree of concern expressed by IWD staff has caused us to elevate their importance in this year’s plan.

Silta yksilöstä yhteisöön : ryhmätyö teatterin tekemisen välineenä

This final thesis focused on experimental knowledge of working in the group. The topic was approached from the perspective of the theatre group director. The thesis itself contains two practical theatre group examples. One is a youngsters' theatre group called La Drama, directed by the author during 2004/2005. The other one is the author's own final artistic production, named Protasio - Kohtaamisia Afrikassa (Protasio - Meeting in Africa), which opened in January 2006. The group leader's role is presented as an important personal tool in theatre, and one that it is important to develop in a professional way. The director's role is to be the promoter of the process, the inspirer and a strong group leader. A person who is in this role will lead the group through the creative process using the community. The thesis identifies and advocates good practice, and ideas of how to create theatre with a group-based method. These analyses can offer useful ideas and knowledge to the beginner in the field of theatre direction.

Rohkeutta henkilöiden käsittelyyn : katsojatutkimus 45 minuuttia -ajankohtaisohjelman henkilökuvajutuista

The present thesis deals with the reception of the celebrity profiles of the MTV3 news current affairs program "45 minuuttia". The target group of the research consists of young adults between the ages from 25 to 34 living in the Helsinki metropolitan area. The research is qualitative and it studies the target group's opinions of the program profiles by the means of a survey and a group interview. In the group interview, the interviewees were also presented sample clips of the program. The results of the survey were analyzed mainly quantitatively. The purpose of the survey results was to map the viewing habits of the target group. In analyzing the results of the group, the interview methods of feedback research and cultural audience research were used. The current thesis was a commissioned research, the purpose of which was to study how interested the young adults are in the program. In addition, the aim was also to find out possible new trends and approaches for the producer of the program. In contrary to the expectations, the reason for the low interest in the profiles seemed to be due to the approach taken to the topics, e.g. the profiled person. By the approach I mean how the person is visually presented or how the person is verbally described. Many people presented in the profiles were regarded as interesting, but at the same time, the way the stories were told was hoped to be more versatile. In addition, a more contemporary visual approach was hoped for. The results also verified the claim that the young adults in general are not interested in the current affair programmes. In addition, these results suggested that in order to obtain more precise information of the viewing preferences of the audience, a more thorough study should be conducted.

Assimilation process in a psychotherapy with a client presenting schizoid personality disorder

The assimilation of problematic experiences has been studied as change processes in psychotherapies of different client populations. Several theory-building case studies using the assimilation model have shown how important a meaning bridge is in such change processes. In a client presenting schizoid personality disorder the creation of meaning as an affect-evoking process may be a particularly important stage in the change process. The present case study aims to apply the assimilation model to a psychotherapy process with a highly disturbed client and focuses on the creation of a meaning bridge in the process. Moreover, the assimilation analysis focuses on the effect of an external person, i.e. the partner or the therapist, when responding to the client's unassimilated problematic experiences. Their effects on the client's assimilation processes are discussed.

Social capabilities in Alzheimer's patients

Patients with stage-I (very mild and mild) Alzheimer's disease were asked to participate in a Dictator Game, a type of game in which a subject has to decide how to allocate a certain amount of money between himself and another person. The game enables the experimenter to examine the influence of social norms and social preferences on the decision-making process. When the results of treatments involving Alzheimer's disease patients were compared with those of identical treatments involving patients with mild cognitive impairment or healthy control subjects, with similar ages and social backgrounds, no statistically significant difference was found. This finding suggests that stage-I Alzheimer's disease patients may be as capable of making decisions involving social norms and preferences as other individuals of their age. Whatever brain structures are affected by the disease, they do not appear to influence, at this early stage, the neural basis for cooperation-enhancing social interactions.

Testing the predictive adaptive response in a host-parasite system

1. Harsh environmental conditions experienced during development can reduce the performance of the same individuals in adulthood. However, the 'predictive adaptive response' hypothesis postulates that if individuals adapt their phenotype during development to the environments where they are likely to live in the future, individuals exposed to harsh conditions in early life perform better when encountering the same harsh conditions in adulthood compared to those never exposed to these conditions before. 2. Using the common vole (Microtus arvalis) as study organism, we tested how exposure to flea parasitism during the juvenile stage affects the physiology (haematocrit, resistance to oxidative stress, resting metabolism, spleen mass, and testosterone), morphology (body mass, testis mass) and motor performance (open field activity and swimming speed) of the same individuals when infested with fleas in adulthood. According to the 'predictive adaptive response' hypothesis, we predicted that voles parasitized at the adult stage would perform better if they had already been parasitized with fleas at the juvenile stage. 3. We found that voles exposed to fleas in adulthood had a higher metabolic rate if already exposed to fleas when juvenile, compared to voles free of fleas when juvenile and voles free of fleas in adulthood. Independently of juvenile parasitism, adult parasitism impaired adult haematocrit and motor performances. Independently of adult parasitism, juvenile parasitism slowed down crawling speed in adult female voles. 4. Our results suggest that juvenile parasitism has long-term effects that do not protect from the detrimental effects of adult parasitism. On the contrary, experiencing parasitism in early-life incurs additional costs upon adult parasitism measured in terms of higher energy expenditure, rather than inducing an adaptive shift in the developmental trajectory. 5. Hence, our study provides experimental evidence for long term costs of parasitism. We found no support for a predictive adaptive response in this host-parasite system.

Cancer risk in the Swiss HIV Cohort Study: associations with immunodeficiency, smoking, and highly active antiretroviral therapy.

BACKGROUND: Persons infected with human immunodeficiency virus (HIV) have an increased risk for several cancers, but the influences of behavioral risk factors, such as smoking and intravenous drug use, and highly active antiretroviral therapy (HAART) on cancer risk are not clear. METHODS: Patient records were linked between the Swiss HIV Cohort Study and Swiss cantonal cancer registries. Observed and expected numbers of incident cancers were assessed in 7304 persons infected with HIV followed for 28,836 person-years. Relative risks for cancer compared with those for the general population were determined by estimating cancer registry-, sex-, age-, and period-standardized incidence ratios (SIRs). RESULTS: Highly elevated SIRs were confirmed in persons infected with HIV for Kaposi sarcoma (KS) (SIR = 192, 95% confidence interval [CI] = 170 to 217) and non-Hodgkin lymphoma (SIR = 76.4, 95% CI = 66.5 to 87.4). Statistically significantly elevated SIRs were also observed for anal cancer (SIR = 33.4, 95% CI = 10.5 to 78.6); Hodgkin lymphoma (SIR = 17.3, 95% CI = 10.2 to 27.4); cancers of the cervix (SIR = 8.0, 95% CI = 2.9 to 17.4); liver (SIR = 7.0, 95% CI = 2.2 to 16.5); lip, mouth, and pharynx (SIR = 4.1, 95% CI = 2.1 to 7.4); trachea, lung, and bronchus (SIR = 3.2, 95% CI = 1.7 to 5.4); and skin, nonmelanomatous (SIR = 3.2, 95% CI = 2.2 to 4.5). In HAART users, SIRs for KS (SIR = 25.3, 95% CI = 10.8 to 50.1) and non-Hodgkin lymphoma (SIR = 24.2, 95% CI = 15.0 to 37.1) were lower than those for nonusers (KS SIR = 239, 95% CI = 211 to 270; non-Hodgkin lymphoma SIR = 99.3, 95% CI = 85.8 to 114). Among HAART users, however, the SIR (although not absolute numbers) for Hodgkin lymphoma (SIR = 36.2, 95% CI = 16.4 to 68.9) was comparable to that for KS and non-Hodgkin lymphoma. No clear impact of HAART on SIRs emerged for cervical cancer or non-acquired immunodeficiency syndrome-defining cancers. Cancers of the lung, lip, mouth, or pharynx were not observed among nonsmokers. CONCLUSION: In persons infected with HIV, HAART use may prevent most excess risk of KS and non-Hodgkin lymphoma, but not that of Hodgkin lymphoma and other non-acquired immunodeficiency syndrome-defining cancers. No cancers of the lip, mouth, pharynx, or lung were observed in nonsmokers.

Content validation of the dimensions constituting non-adherence to treatment of arterial hypertension

The objective of the study was to validate the content of the dimensions that constituted nonadherence to treatment of arterial systemic hypertension. It was a methodological study of content validation. Initially an integrative review was conducted that demonstrated four dimensions of nonadherence: person, disease/treatment, health service, and environment. Definitions of these dimensions were evaluated by 17 professionals, who were specialists in the area, including: nurses, pharmacists and physicians. The Content Validity Index was calculated for each dimension (IVCi) and the set of the dimensions (IVCt), and the binomial test was conducted. The results permitted the validation of the dimensions with an IVCt of 0.88, demonstrating reasonable systematic comprehension of the phenomena of nonadherence.

Do the Wealthy Risk More Money? An Experimental Comparison

Are poor people more or less likely to take money risks than wealthy folks? We find that risk attraction is more prevalent among the wealthy when the amounts of money at risk are small (not surprising, since ten dollars is a smaller amount for a wealthy person than for a poor one), but, interestingly, for the larger amounts of money at risk the fraction of the nonwealthy displaying risk attraction exceeds that of the wealthy. We also replicate our previous finding that many people display risk attraction for small money amounts, but risk aversion for large ones. We argue that preferences yielding risk attraction for small money amounts, together with risk aversion for larger amounts, at all levels of wealth, while contradicting the expected utility hypothesis, may be well-defined, independently of reference points, on the choice space.

Improved smoking cessation in smokers given ultrasound photographs of their own atherosclerotic plaques.

BACKGROUND: We examined whether making smokers aware that they had developed peripheral atherosclerosis would improve smoking cessation. METHODS: Smokers selected from the general population were randomly allocated to undergo high-resolution B-mode ultrasonography of their carotid and femoral arteries. All smokers received quit-smoking counseling. Smokers with > or =1 atherosclerotic plaque were given two photographs of a plaque with a relevant explanation. Quit rates were assessed by telephone 6 months later. RESULTS: Seventy-nine smokers did not undergo ultrasonography (A). Among the 74 smokers submitted to ultrasonography, 20 had no plaque (B) and 54 had > or =1 plaque (C). Quit rates were, respectively, 6.3, 5.0, and 22.2% in groups A, B, and C. Quit rates were higher in smokers submitted to ultrasonography (B + C vs A; P = 0.031) and in those receiving photographs (C vs A + B; P = 0.003). Smoking cessation was independently associated with intervention C (OR = 6.2; 95% CI = 1.8-21) and a white-collar job but not with age or gender. CONCLUSIONS: Providing smokers with photographs demonstrating atherosclerosis on their own person was an effective adjunct to physician's advice to quit smoking. Since ultrasonography is used increasingly often in clinical practice for cardiovascular risk stratification, this can provide an additional opportunity and means to deter smokers from smoking.