Iowa Leading Indicators Index January 2009

The Iowa Leading Indicators Index (ILII) is a tool for monitoring the future direction of the Iowa economy and State revenues. Its eight components include an agricultural futures price index, an Iowa stock market index, average weekly manufacturing hours in Iowa, initial unemployment claims in Iowa, an Iowa new orders index, diesel fuel consumption in Iowa, residential building permits in Iowa, and the national yield spread.

Independent Living Program, Vol. 1, 2008

The Iowa Department for the Blind is the state agency that serves Iowans with vision loss. Services are free, confidential and available statewide. "There are no limitations to what you can do with training and a positive attitude." (All quotes in this newsletter are from former training participants). At the Iowa Department for the Blind, we believe in a positive approach to blindness. Vision loss alone should not prevent anyone from being independent. For this reason, we offer a wide variety of opportunities to obtain the skills necessary for independence.

Independent Living Program, Vol. 2, 2008

The Iowa Department for the Blind is the state agency that serves Iowans with vision loss. Services are free, confidential and available statewide. "There are no limitations to what you can do with training and a positive attitude." (All quotes in this newsletter are from former training participants). At the Iowa Department for the Blind, we believe in a positive approach to blindness. Vision loss alone should not prevent anyone from being independent. For this reason, we offer a wide variety of opportunities to obtain the skills necessary for independence.

Independent Living Program, Vol. 3, 2008

The Iowa Department for the Blind is the state agency that serves Iowans with vision loss. Services are free, confidential and available statewide. "There are no limitations to what you can do with training and a positive attitude." (All quotes in this newsletter are from former training participants). At the Iowa Department for the Blind, we believe in a positive approach to blindness. Vision loss alone should not prevent anyone from being independent. For this reason, we offer a wide variety of opportunities to obtain the skills necessary for independence.

Performance Report for Fiscal Year, 2008

I am pleased to present the performance report for the Iowa Department for the Blind for fiscal year 2008. This report is provided in compliance with sections 8E.210 and 216B.7 of the Code of Iowa. It contains valuable information about results achieved because of the services that we and our partners provided to blind and visually impaired Iowans during the past fiscal year in the areas of Vocational Rehabilitation, Independent Living, Library Services, and Resource Management. We determine our competitive success in a number of ways. We look at the federal standards and indicators to learn our ranking in relation to the performance of other public rehabilitation agencies. We compare our library's production and circulation figures with those from previous years to determine trends. We set our own standards for success by looking at such factors as the number of successful case closures, average hourly wage at case closure, skills training provided, and compliance with regulations. Results show that the Department is working positively toward achieving its strategic goals of increasing the independence and productivity of blind Iowans and improving access to information for blind Iowans. Major accomplishments of the year included:  The selection of our Library as one of eight libraries to receive the new digital talking book machines and books in digital media from the National Library Service for the Blind and Physically Handicapped. Priority for distribution of the machines is given to Library patrons who are veterans.  The Department, the Iowa Braille School, and the Department of Education have been promoting the new expanded core curriculum as part of their continued efforts to improve the coordination and delivery of services to blind and visually impaired students in Iowa.  The Department's five-year grant funded Pathfinders mentoring program ended this year. A total of 49 blind youths aged 16-26 were paired with successful blind adult mentors. Assessments of the program clearly showed that participation in the program had a measurable positive effect on the youth involved.  Finally, earnings ratios and the percentage of employment for vocational rehabilitation clients of the Department are among the best in the nation, as measured by the U.S. Rehabilitation Services Administration's standards and indicators for the year ended September 30, 2007. Overall, we met or exceeded 13 of 18 targets included in this report. A discussion of the Department's services, customers, and organizational structure, and budget appears in the "Department Overview" that follows. Information pertaining to performance results appears in the final section of this document. The success of the Department's programs is evident in the success achieved by blind Iowans. It is reflected in the many blind persons who can be seen traveling about independently, going to their jobs and to the community and family activities in which they participate. Sincerely, Karen A. Keninger, Director Iowa Department for the Blind

Living Near A Vineyard

It is widely assumed that living in rural Iowa means you live near a field of corn or soybeans. It is common to see large equipment during spring and fall and most people are aware that care should be given when using certain pesticides near these fields. In general, most everyone knows what to expect. Now there’s something new dotting the Iowa landscape . . . Vineyards! Like row crops, vineyards also use farm equipment and pesticides. We would like to take you on a written tour of what you might expect in a vineyard throughout our growing season. For a “real” tour, contact a local grape grower!

Iowa Leading Indicators Index, February 2009

The Iowa Leading Indicators Index (ILII) is a tool for monitoring the future direction of the Iowa economy and State revenues. Its eight components include an agricultural futures price index, an Iowa stock market index, average weekly manufacturing hours in Iowa, initial unemployment claims in Iowa, an Iowa new orders index, diesel fuel consumption in Iowa, residential building permits in Iowa, and the national yield spread.

Iowa Leading Indicators Index March 2009

The Iowa Leading Indicators Index (ILII) is a tool for monitoring the future direction of the Iowa economy and State revenues. Its eight components include an agricultural futures price index, an Iowa stock market index, average weekly manufacturing hours in Iowa, initial unemployment claims in Iowa, an Iowa new orders index, diesel fuel consumption in Iowa, residential building permits in Iowa, and the national yield spread.

Iowa Leading Indicators Index, April 2009

The Iowa Leading Indicators Index (ILII) is a tool for monitoring the future direction of the Iowa economy and State revenues. Its eight components include an agricultural futures price index, an Iowa stock market index, average weekly manufacturing hours in Iowa, initial unemployment claims in Iowa, an Iowa new orders index, diesel fuel consumption in Iowa, residential building permits in Iowa, and the national yield spread.

Iowa Leading Indicators Index, May 2009

The Iowa Leading Indicators Index (ILII) is a tool for monitoring the future direction of the Iowa economy and State revenues. Its eight components include an agricultural futures price index, an Iowa stock market index, average weekly manufacturing hours in Iowa, initial unemployment claims in Iowa, an Iowa new orders index, diesel fuel consumption in Iowa, residential building permits in Iowa, and the national yield spread.

Iowa Leading Indicators Index, June 2009

The Iowa Leading Indicators Index (ILII) is a tool for monitoring the future direction of the Iowa economy and State revenues. Its eight components include an agricultural futures price index, an Iowa stock market index, average weekly manufacturing hours in Iowa, initial unemployment claims in Iowa, an Iowa new orders index, diesel fuel consumption in Iowa, residential building permits in Iowa, and the national yield spread.

Nonanesthesiologist-administered propofol sedation: from the exception to standard practice. Sedation and monitoring trends over 20 years.

The practice of sedation, including monitoring practice for digestive endoscopy, continues to evolve throughout the world. In many countries, including Switzerland, there is a trend towards increased utilization of sedation during both routine and advanced endoscopic procedures. Sedation improves patient satisfaction with endoscopy and also improves the quality of the examination. In addition, a trend can be observed towards an increasing use of propofol as the preferred sedative drug. Here we review the latest published data from surveys describing sedation and monitoring practice in different countries and compare them with our own data from successive nationwide surveys among Swiss gastroenterologists over a period of 20 years. This development between these socioeconomically very similar Western industrialized countries, however, shows some unique and surprising differences. In Germany and Switzerland, propofol use has become increasingly widespread, in Switzerland even to the extent that during the last few years propofol has overtaken benzodiazepine sedation, with an absolute majority of Swiss gastroenterologists using it without the assistance of an anesthesiologist. In addition, the change in Switzerland reflects a successful generalization of nonanesthesiologist-administered propofol (NAAP) sedation from the hospital setting to private practice.

Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status.

OBJECTIVE: To validate a revision of the Mini Nutritional Assessment short-form (MNA(R)-SF) against the full MNA, a standard tool for nutritional evaluation. METHODS: A literature search identified studies that used the MNA for nutritional screening in geriatric patients. The contacted authors submitted original datasets that were merged into a single database. Various combinations of the questions on the current MNA-SF were tested using this database through combination analysis and ROC based derivation of classification thresholds. RESULTS: Twenty-seven datasets (n=6257 participants) were initially processed from which twelve were used in the current analysis on a sample of 2032 study participants (mean age 82.3y) with complete information on all MNA items. The original MNA-SF was a combination of six questions from the full MNA. A revised MNA-SF included calf circumference (CC) substituted for BMI performed equally well. A revised three-category scoring classification for this revised MNA-SF, using BMI and/or CC, had good sensitivity compared to the full MNA. CONCLUSION: The newly revised MNA-SF is a valid nutritional screening tool applicable to geriatric health care professionals with the option of using CC when BMI cannot be calculated. This revised MNA-SF increases the applicability of this rapid screening tool in clinical practice through the inclusion of a "malnourished" category.

Indicators used by clinicians to assess pain in the brain injured

INTRODUCTION. The assessment of pain in critically ill brain-injured patients is challenging for health professionals. In addition to be unable to self-report, the confused and stereotyped behaviors of these patients are likely to alter their ''normal'' pain responses. Therefore, the pain indicators observed in the general critically ill population may not be appropriate. OBJECTIVES. To identify behavioral and physiological indicators used by clinicians to assess pain in critically ill brain-injured patients who are unable to self-report. METHODS.Amixed-method design was used with the first step being the combination of the results of an integrative literature review with the results of nominal groups of 12 nurses and four physicians. The second step involved a web-based survey to establish content validity. Fourteen experts (clinicians and academics) from three French speaking European countries rated the relevance of each indicator. A content validity index (CVI) was computed for each indicator (I-CVI) and for each category (S-CVI). RESULTS. The first step generated 52 indicators. These indicators were classified into six categories: facial expressions, position/movement, muscle tension, vocalization, compliance with ventilator, and physiological indicators. In the second step, the agreement between raters was high with an Intraclass Correlation Coefficient of 0.88 (95% CI 0.83-0.92). The I-CVIs ranged from 0.07 to 1. Indicators with an I-CVI below 0.5 (n = 12) were not retained, resulting in a final list of 30 indicators. The CVI for this final list was 0.75 with categories ranging from 0.67 (compliance with ventilation) to 0.87 (vocalization). CONCLUSIONS. This process identified specific pain indicators for critically ill braininjured patients. Further evaluation is in progress to test the validity and relevance of these indicators in the clinical setting.

Iowa Leading Indicators Index after One Year: An Assessment and Update

The Iowa Leading Indicators Index (ILII) Annual Assessment and Update assesses how well the ILII has met the goals behind its development, gauges the validity of the existing components, considers additional components that have been suggested along the way, and carries out the annual updates necessary for such an index.