Geographic Barriers to Indexing: Examining Appalachia.

The objective of this study was to examine the accuracy of indexing for "Appalachian Region"[Mesh]. Researchers performed a search in PubMed for articles published in 2019 using "Appalachian Region"[Mesh] or "Appalachia" or "Appalachian" in the title or abstract. Only 17.88% of the articles retrieved by the search were about Appalachia according to the ARC definition. Most articles retrieved appeared because they were indexed with state terms that were included as part of the mesh term. Database indexing and searching transparency is of growing importance as indexers rely increasingly on automated systems to catalog information and publications.

Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association.

BACKGROUND: Uncompensated vestibular hypofunction can result in symptoms of dizziness, imbalance, and/or oscillopsia, gaze and gait instability, and impaired navigation and spatial orientation; thus, may negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work. It is estimated that one-third of adults in the United States have vestibular dysfunction and the incidence increases with age. There is strong evidence supporting vestibular physical therapy for reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction. The purpose of this revised clinical practice guideline is to improve quality of care and outcomes for individuals with acute, subacute, and chronic unilateral and bilateral vestibular hypofunction by providing evidence-based recommendations regarding appropriate exercises. METHODS: These guidelines are a revision of the 2016 guidelines and involved a systematic review of the literature published since 2015 through June 2020 across 6 databases. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case-control series, and case series for human subjects, published in English. Sixty-seven articles were identified as relevant to this clinical practice guideline and critically appraised for level of evidence. RESULTS: Based on strong evidence, clinicians should offer vestibular rehabilitation to adults with unilateral and bilateral vestibular hypofunction who present with impairments, activity limitations, and participation restrictions related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) to promote gaze stability. Based on moderate to strong evidence, clinicians may offer specific exercise techniques to target identified activity limitations and participation restrictions, including virtual reality or augmented sensory feedback. Based on strong evidence and in consideration of patient preference, clinicians should offer supervised vestibular rehabilitation. Based on moderate to weak evidence, clinicians may prescribe weekly clinic visits plus a home exercise program of gaze stabilization exercises consisting of a minimum of: (1) 3 times per day for a total of at least 12 minutes daily for individuals with acute/subacute unilateral vestibular hypofunction; (2) 3 to 5 times per day for a total of at least 20 minutes daily for 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction; (3) 3 to 5 times per day for a total of 20 to 40 minutes daily for approximately 5 to 7 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may prescribe static and dynamic balance exercises for a minimum of 20 minutes daily for at least 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction and, based on expert opinion, for a minimum of 6 to 9 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may use achievement of primary goals, resolution of symptoms, normalized balance and vestibular function, or plateau in progress as reasons for stopping therapy. Based on moderate to strong evidence, clinicians may evaluate factors, including time from onset of symptoms, comorbidities, cognitive function, and use of medication that could modify rehabilitation outcomes. DISCUSSION: Recent evidence supports the original recommendations from the 2016 guidelines. There is strong evidence that vestibular physical therapy provides a clear and substantial benefit to individuals with unilateral and bilateral vestibular hypofunction. LIMITATIONS: The focus of the guideline was on peripheral vestibular hypofunction; thus, the recommendations of the guideline may not apply to individuals with central vestibular disorders. One criterion for study inclusion was that vestibular hypofunction was determined based on objective vestibular function tests. This guideline may not apply to individuals who report symptoms of dizziness, imbalance, and/or oscillopsia without a diagnosis of vestibular hypofunction. DISCLAIMER: These recommendations are intended as a guide to optimize rehabilitation outcomes for individuals undergoing vestibular physical therapy. The contents of this guideline were developed with support from the American Physical Therapy Association and the Academy of Neurologic Physical Therapy using a rigorous review process. The authors declared no conflict of interest and maintained editorial independence.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A369).

Improving the Integration of Restoration and Conservation in Marine and Coastal Ecosystems: Lessons from the Deepwater Horizon Disaster.

In the wake of the Deepwater Horizon disaster, much has been learned about the biological, ecological, physical, and chemical conditions of the Gulf of Mexico. In parallel, the research community has also gained insight about the social and organizational structures and processes necessary for oil spill response and subsequent marine and coastal restoration. However, even with these lessons from both the Deepwater Horizon and previous spills, including 1989's Exxon Valdez and the Ixtoc 1 in 1979, our understanding of how to avoid future crises has not advanced at the same pace as offshore oil and gas development. We argue that this progress deficit indicates a continued devaluing of marine and coastal resources. We believe that we must, instead, advance a proactive conservation ethic based on the precautionary principle and an appropriately placed burden of proof-strategies that will help reduce our reliance on costly restoration and protect marine and coastal ecosystems.

Reevaluating Point-of-Care Resources: Community Engagement in Difficult Collection Choices.

Rising collection costs sometimes necessitate tough decisions regarding cancellation of popular products. In 2015-2016, the East Tennessee State University Medical Library subscribed to UpToDate and DynaMed Plus, both clinical point-of-care products, with the understanding that one product would be canceled at the fiscal year end. The librarian team undertook a year-long community engagement campaign to inform library users about the pending product cancellation decision. Ultimately, DynaMed Plus was selected and UpToDate was cancelled. The campaign generated user engagement with the decision making, along with perceived benefits including increased awareness of the library's budget constraints, increased discussion of scholarly publishing, and greater faculty/student knowledge of evaluating evidence-based products.

A mixed-methods analysis of a library-based hand-held intervention with rural clinicians.

BACKGROUND: The East Tennessee State University Quillen College of Medicine Library has participated for several years in projects to provide rural clinicians with health information resources. OBJECTIVES: To determine whether a strategy of hand-held devices with a best-evidence point-of-care disease tool and a drug database paired with access to a medical library for full-text articles and training to use the tools would be an affordable way to meet the information needs of rural underserved clinicians. METHODS: This study is a mixed-methods methodology. The first project was evaluated using a randomised controlled trial (RCT) methodology. The second was evaluated qualitatively using interviews and focus groups. RESULTS: The quantitative findings discovered that clinicians equipped with a hand-held device with evidence-based software more frequently found answers to clinical questions, found answers more quickly, were more satisfied with information they found and use expensive resources such as continuing medical education, online databases and textbooks less than the group that did not have access to online technology. Qualitative results supported the quantitative findings. CONCLUSION: Librarians can implement a three-pronged strategy of the secondary literature via a hand-held, the primary literature via Loansome Doc and quality training to meet basic information needs of rural clinicians.

College and university environmental programs as a policy problem (part 2): strategies for improvement.

Environmental studies and environmental sciences programs in American and Canadian colleges and universities seek to ameliorate environmental problems through empirical enquiry and analytic judgment. In a companion article (Part 1) we describe the environmental program movement (EPM) and discuss factors that have hindered its performance. Here, we complete our analysis by proposing strategies for improvement. We recommend that environmental programs re-organize around three principles. First, adopt as an overriding goal the concept of human dignity-defined as freedom and social justice in healthy, sustainable environments. This clear higher-order goal captures the human and environmental aspirations of the EPM and would provide a more coherent direction for the efforts of diverse participants. Second, employ an explicit, genuinely interdisciplinary analytical framework that facilitates the use of multiple methods to investigate and address environmental and social problems in context. Third, develop educational programs and applied experiences that provide students with the technical knowledge, powers of observation, critical thinking skills and management acumen required for them to become effective professionals and leaders. Organizing around these three principles would build unity in the EPM while at the same time capitalizing on the strengths of the many disciplines and diverse local conditions involved.

College and university environmental programs as a policy problem (part 1): integrating knowledge, education, and action for a better world?

The environmental sciences/studies movement, with more than 1000 programs at colleges and universities in the United States and Canada, is unified by a common interest-ameliorating environmental problems through empirical enquiry and analytic judgment. Unfortunately, environmental programs have struggled in their efforts to integrate knowledge across disciplines and educate students to become sound problem solvers and leaders. We examine the environmental program movement as a policy problem, looking at overall goals, mapping trends in relation to those goals, identifying the underlying factors contributing to trends, and projecting the future. We argue that despite its shared common interest, the environmental program movement is disparate and fragmented by goal ambiguity, positivistic disciplinary approaches, and poorly rationalized curricula, pedagogies, and educational philosophies. We discuss these challenges and the nature of the changes that are needed in order to overcome them. In a subsequent article (Part 2) we propose specific strategies for improvement.

Exploratory spatial data analysis of regional seroprevalence of antibodies against epizootic hemorrhagic disease virus in cattle from Illinois and Indiana.

OBJECTIVE: To estimate seroprevalence of antibodies against the serogroup of epizootic hemorrhagic disease viruses (EHDVs) and describe spatial distribution of antibodies against EHDV among cattle herds in Illinois and western Indiana. SAMPLE POPULATION: 9,414 serum samples collected from cattle in 60 herds over 3 transmission seasons. PROCEDURES: Serum samples were tested for antibodies against EHDV by use of an ELISA. Seroprevalence for 4 zones covering the length of Illinois and parts of Indiana were estimated. A multivariable mixed-effects logistic regression model with a random effect for herd was used to estimate seropositive risk for zone (1 through 4), age (yearling, adult), herd type (beef, dairy), transmission season (2000 to 2002), and zone by year interaction. Isopleth maps of seroprevalence at the herd level were produced. RESULTS: Antibodies against EHDV were detected in 1,110 (11.8%) samples. Estimated seroprevalence in 2000, 2001, and 2002 was 15.3%, 13.4%, and 5.2%, respectively. Seroprevalence was highest in the southernmost zone and lowest in the northernmost zone, but risk of seropositivity for EHDV among and within zones varied by year. Clusters of high seroprevalence in the south, low seroprevalence in the north, and outliers of high and low seroprevalence were detected. Risk mapping revealed areas of higher seroprevalence extending northward along the western and eastern ends of the study region. CONCLUSIONS: Seroprevalence of antibodies against EHDV in cattle was higher in the south than north; however, local complexities existed that were not observed in a serosurvey of antibodies against bluetongue virus from the same cattle population.

Effects of therapeutic ceftiofur administration to dairy cattle on Escherichia coli dynamics in the intestinal tract.

The goal of this study was to follow ceftiofur-treated and untreated cattle in a normally functioning dairy to examine enteric Escherichia coli for changes in antibiotic resistance profiles and genetic diversity. Prior to treatment, all of the bacteria cultured from the cows were susceptible to ceftiofur. Ceftiofur-resistant E. coli was only isolated from treated cows during and immediately following the cessation of treatment, and the 12 bla(CMY-2)-positive isolates clustered into two genetic groups. E. coli bacterial counts dropped significantly in the treated animals (P < 0.027), reflecting a disappearance of the antibiotic-susceptible strains. The resistant bacterial population, however, did not increase in quantity within the treated cows; levels stayed low and were overtaken by a returning susceptible population. There was no difference in the genetic diversities of the E. coli between the treated and untreated cows prior to ceftiofur administration or after the susceptible population of E. coli returned in the treated cows. A cluster analysis of antibiotic susceptibility profiles resulted in six clusters, two of which were multidrug resistant and were comprised solely of isolates from the treated cows immediately following treatment. The antibiotic treatment provided a window to detect the presence of ceftiofur-resistant E. coli but did not appear to cause its emergence or result in its amplification. The finding of resistant isolates following antibiotic treatment is not sufficient to estimate the strength of selection pressure nor is it sufficient to demonstrate a causal link between antibiotic use and the emergence or amplification of resistance.

Regional seroprevalence of bluetongue virus in cattle in Illinois and western Indiana.

OBJECTIVE: To estimate seroprevalence of bluetongue virus (BTV) and the geographic distribution of seropositive cattle herds in Illinois and western Indiana. SAMPLE POPULATION: 10,585 serum samples obtained from cattle in 60 herds during 3 transmission seasons (2000 through 2002). PROCEDURES: In a longitudinal study, serum samples were tested for BTV antibodies by use of a competitive ELISA. Four geographic zones were created by use of mean minimum January temperature. A multivariable mixed-effects logistic regression model with a random effect for herd was used to estimate seropositive risk for zone, age of cattle, herd type, and transmission season. RESULTS: Overall, BTV antibodies were detected in 156 (1.5%) samples. Estimated seroprevalence in 2000, 2001, and 2002 was 1.49%, 0.97%, and 2.18%, respectively. Risk of being seropositive for BTV was associated with geographic zone and age. Seroprevalence increased progressively from northern to southern zones, with no evidence of BTV infection in the northernmost zone. In the southernmost zone, annual seroprevalence ranged from 8.65% to 11.00%. Adult cattle were 2.35 times as likely as juvenile cattle to be seropositive. CONCLUSIONS AND CLINICAL RELEVANCE: Overall seroprevalence was lower than has been reported for Illinois cattle. Bluetongue virus antibodies were distributed heterogeneously in this region. Only in the southernmost zone was seroprevalence consistently > 2%. Regionalization of BTV risk based on state borders does not account for such variability. Serologic data could be combined with landscape, climate, and vector data to develop predictive models of BTV risk within transitional regions of the United States.

Use of pooled samples for the detection of Salmonella in feces by polymerase chain reaction.

Many epidemiological studies of Salmonella rely on conventional bacteriological culture methods to detect Salmonella in fecal samples. These culture-based methods are inefficient for epidemiological studies in populations with a low prevalence of Salmonella. The objective of this study was to optimize a protocol that uses pooled Salmonella enrichment broth cultures of bovine feces and polymerase chain reaction (PCR) for the detection of the invA gene of Salmonella in feces. In one field trial, 196 animals were sampled, and all samples were tested by culture, invA PCR on individual samples, invA PCR on pools of 5 samples, and BAX PCR on individual samples. All assays showed a high agreement on individual samples (kappa > or = 0.75). The invA PCR was run on each of 40 pools and detected 19 of 22 culture-positive pools. In another field trial, 152 samples were taken from 4 dairies, and the invA PCR was performed on pools of 5 samples in addition to bacteriological culture of individual samples. Salmonella was detected in 5 of the 32 pools (7 total positive samples) by both PCR and culture. One pool was PCR-positive but culture-negative. Pooling did not dramatically affect the performance of the invA PCR; most of the culture-positive samples were detected, including all of the samples when there were 4 or more Salmonella colonies on the agar plate. Based on these field trials, invA PCR on pooled samples appears to be an efficient method of Salmonella detection as long as Salmonella loads are not extremely low.

Community partnerships for health information training: medical librarians working with health-care professionals and consumers in Tennessee.

In Tennessee, several medical library outreach projects have involved collaborative work with health-care professionals, public librarians, consumers, faith-based organizations and community service agencies. The authors are medical librarians who worked as consultants, trainers and project directors to promote health literacy using PubMed medline and other health information resources in the several funding projects described here. We explain the programmes briefly, focusing on lessons learned and suggestions for those who follow us.