Iowa Byways: The Official Guide to Iowa Byways, 2013

Browse through this guide and you’ll find the distinct flavor of what is available along each byway. Discover recreational, historic, cultural and scenic attractions using the maps and lists provided in the guide. You’ll find numbered attractions for each byway in or near the town listed. For a comprehensive list of byway features, visit www.iowabyways.org. Friendly local contacts are provided to help you along the way. Iowa Transportation Maps clearly tracking all the Iowa byways with red dotted lines are available at Iowa’s official welcome centers. Traveling Iowa’s byways you will experience small town America, while enjoying diverse landscapes and unique landforms that have been shaped over thousands of years. Iowa’s cultural heritage also plays a major role across all 11 byways, boasting hundreds of historic sites, national landmarks and interpretive centers, each telling Iowa’s stories from the first Native Americans through European immigrants to modern times. Glaciers once covered much of Iowa, shaping the broad flat plains of the prairie. These massive sheets of ice missed the northeast corner of the state, leaving the land along the Driftless Area Byway rugged and hilly with rock outcroppings, springs and cold water trout streams. Rivers coursed their way through the land, carving deep furrows in some places and leaving gently rolling hills in others. In western Iowa, wind has shaped fine sand into the impressive Loess Hills, a rare land form found in only one other place on earth. Iowa’s two national scenic byways and nine state byways offer unique varieties of scenic features, and more for you to see and do. View three states from atop a Mississippi River bluff, stop at a modern art museum and then tour a working farm. Explore a historic mill, visit a national aquarium, take a boat ride in a cave, purchase locally crafted pottery and wares from local artisans or trace the footsteps of Lewis and Clark. Experience the actual wagon ruts of the Mormon Trail, ride your bike 13 stories high, canoe a water trail, star gaze under Iowa’s darkest sky, and marvel at mounds built by prehistoric cultures. Agriculture wraps Iowa’s byways with an abundance of farmland vistas and fills Iowa lands with ever-changing crops and activities for you to “harvest.” You’ll see croplands on the vast flat plains and farmsteads sprinkled across rolling hills reminiscent of a Grant Wood painting. Along the way, you might wander in a corn maze, rest at a bed and breakfast, study farming in museums, discover the Iowa barn quilt collection or visit a working Amish farm. When you are ready to step outside your vehicle, you’ll find much more to do and see. Prairie, forests, rivers and public lands are abundant along Iowa’s byways; providing opportunities for you to stop and play in the outdoors with hiking, biking, kayaking and trout fishing. Classic hometowns with pride for their unique lore and offerings are found all along the byways. They invite you to taste local food, enjoy their architecture, and immerse yourself in the rich history and culture that defines them. Why not plan your next journey off the beaten path? No matter how you choose to make the most of every moment, we know that time spent along Iowa’s byways is sure to grow your love for Iowa’s diverse, beautiful vistas and authentic communities. Happy driving!

First explicit criteria to decide on the appropriateness of therapy of ulcerative colitis: the European EPATUC panel

Background: Ulcerative colitis (UC) is a chronic disease with a wide variety of treatment options many of which are not evidence based. Supplementing available guidelines, which are often broadly defined, consensus-based and generally not tailored to specifically reflect the individual patient situation, we developed explicit appropriateness criteria to assist, and improve treatment decisions. Methods: We used the RAND appropriateness method which does not force consensus. An extensive literature review was compiled based on and supplementing, where necessary, the ECCO UC 2011 guidelines. EPATUC (endorsed by ECCO) was formed by 7 gastroenterologists, 2 surgeons and 2 general practitioners from throughout Europe. Clinical scenarios reflecting practice were rated on a 9-point scale from 1 (extremely inappropriate) to 9 (extremely appropriate), based on the expert's experience and the available literature. After extensive discussion, all scenarios were re-rated at a two-day panel meeting. Median and disagreement (D) were used to categorize ratings into 3 categories: appropriate (A), uncertain (U) and inappropriate (I). Results: 718 clinical scenarios were rated, structured in 13 main clinical presentations: not refractory (n = 64) or refractory (n = 33) proctitis, mild to moderate left-sided (n = 72) or extensive (n = 48) colitis, severe colitis (n = 36), steroid- dependant colitis (n = 36), steroid-refractory colitis (n = 55), acute pouchitis (n = 96), maintenance of remission (n = 248), colorectal cancer prevention (n = 9) and fulminant colitis (n = 9). Overall, 100 indications were judged appropriate (14%), 129 uncertain (18%) and 489 inappropriate (68%). Disagreement between experts was very low (6%). Conclusions: For the very first time, explicit appropriateness criteria for therapy of UC were developed that allow both specific and rapid therapeutic decision making and prospective assessment of treatment appropriateness. Comparison of these detailed scenarios with patient profiles encountered in the Swiss IBD cohort study indicates good concordance. EPATUC criteria will be freely accessible on the internet (epatuc.ch)

The european higher education area at work: Lights and shadows defining continuous assessment

The aim of this paper is to analyse how learning assessment, particularly the Continuous Assessment system, has been defined in the Public Administration and Management Diploma Course of the University of Barcelona (Spain). This course was a pioneering experiment at this university in implementing the guidelines of the European Higher Education Area (EHEA), and thus represents a good case study for verifying whether one of the cornerstones of the EHEA has been accomplished with success. Using data obtained from the Teaching Plans elaborated by the lecturers of each subject, we are able to establish that the CA system has been progressively accepted to such an extent that it is now the assessment formula used by practically all of the lecturers, conforming in this way to the protocols laid down by the Faculty of Law in which this diploma course is taught. Nevertheless, we find that high dispersion exists in how Continuous Assessment is actually defined. Indeed, it seems that there is no unified view of how Continuous Assessment should be performed. This dispersion, however, seems to diminish over time and raises some questions about the advisability of agreement on criteria, considering the potential which CA has as a pedagogical tool. Moreover, we find that the Unique Assessment system, which students may also apply for, is an option chosen only by a minority, with lecturers usually defining it as merely a theoretical and/or practical test, of little innovation in relation to traditional tests.

Soils in a young landscape on the coast of southern Finland

Selostus: Nuoria maita Viikin pelloilla

Do we fear tax competition among new and old European countries ?

The purpose of this paper is to study both theoretically and empirically tax competition in the enlarged EU and to provide some insights on ongoing reforms concerning business taxation. We support the idea that even if one can observe cuts in "new" members statutory business tax rates, this should not result in fiercer tax competition between the "core" and "the "periphery" since infrastructure endowments and the existence of agglomeration rents in the core of the EU may prevent (at least partially) activities to relocate to the "new" members.

Radiation protection in digestive endoscopy: European Society of Digestive Endoscopy (ESGE) guideline.

This article expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about radiation protection for endoscopic procedures, in particular endoscopic retrograde cholangiopancreatography (ERCP). Particular cases, including pregnant women and pediatric patients, are also discussed. This Guideline was developed by a group of endoscopists and medical physicists to ensure that all aspects of radiation protection are adequately dealt with. A two-page executive summary of evidence statements and recommendations is provided. The target readership for this Guideline mostly includes endoscopists, anesthesiologists, and endoscopy assistants who may be exposed to X-rays during endoscopic procedures.

Senecio pterophorus DC., a new alien species in the European mainland

Senecio pterophorus DC. is an erect, semilignose shrub (fig. 1) which grows up to 2 m high. Is a chamaephyte basipetal branch-shedder (ORSHAN, Plant pheno-morphological studies in Mediterranean type ecosystems: 210-211. 1989) whose new branches appear below inflorescences but not from the lower parts of the plant. Leaves lanceolate. Stems are annual and develop at their apex a great number of small (up to 15 mm in diameter) yellow capitula which are grouped in a corymbose-paniculated inflorescence (HARVEY & SONDER, Flora Capensis: Cape Colony, Caffraria & Port Natal 3: 386.1865).

Detection of HIV drug resistance during antiretroviral treatment and clinical progression in a large European cohort study.

OBJECTIVE(S): To investigate the relationship between detection of HIV drug resistance by 2 years from starting antiretroviral therapy and the subsequent risk of progression to AIDS and death. DESIGN: Virological failure was defined as experiencing two consecutive viral loads of more than 400 copies/ml in the time window between 0.5 and 2 years from starting antiretroviral therapy (baseline). Patients were grouped according to evidence of virological failure and whether there was detection of the International AIDS Society resistance mutations to one, two or three drug classes in the time window. METHODS: Standard survival analysis using Kaplan-Meier curves and Cox proportional hazards regression model with time-fixed covariates defined at baseline was employed. RESULTS: We studied 8229 patients in EuroSIDA who started antiretroviral therapy and who had at least 2 years of clinical follow-up. We observed 829 AIDS events and 571 deaths during 38,814 person-years of follow-up resulting in an overall incidence of new AIDS and death of 3.6 per 100 person-years of follow-up [95% confidence interval (CI):3.4-3.8]. By 96 months from baseline, the proportion of patients with a new AIDS diagnosis or death was 20.3% (95% CI:17.7-22.9) in patients with no evidence of virological failure and 53% (39.3-66.7) in those with virological failure and mutations to three drug classes (P = 0.0001). An almost two-fold difference in risk was confirmed in the multivariable analysis (adjusted relative hazard = 1.8, 95% CI:1.2-2.7, P = 0.005). CONCLUSION: Although this study shows an association between the detection of resistance at failure and risk of clinical progression, further research is needed to clarify whether resistance reflects poor adherence or directly increases the risk of clinical events via exhaustion of drug options.