Are adolescent idiopathic scoliosis and ankylosing spondylitis counter-opposing conditions? A hypothesis on biomechanical contributions predisposing to these spinal disorders.

Human spinal biomechanics are profoundly complex and not well understood, especially in terms of the dynamic spine function. Translation of biomechanics to disease is difficult, particularly since cause must be separated from effect. Primary dynamics predisposing to the onset of chronic spinal disorders, e.g., adolescent idiopathic scoliosis (AIS) or ankylosing spondylitis (AS), must clearly be differentiated from secondary alterations. This commentary addresses primary biomechanics that may predispose to these idiopathic diseases. A novel hypothesis is proposed, based upon inferences regarding their contrasting muscular dynamics. The hypothesis postulates opposing inherent muscle tonicity in AIS versus AS. Converse degrees of spinal stability may predispose to the respective curvature deformities of AIS and the enthesopathy lesions of AS. One condition is suspected to counter-oppose the other, within a polymorphic spectrum of spinal stability.

Cry1A toxins of Bacillus thuringiensis bind specifically to a region adjacent to the membrane-proximal extracellular domain of BT-R(1) in Manduca sexta: involvement of a cadherin in the entomopathogenicity of Bacillus thuringiensis.

Many subspecies of the soil bacterium Bacillus thuringiensis produce various parasporal crystal proteins, also known as Cry toxins, that exhibit insecticidal activity upon binding to specific receptors in the midgut of susceptible insects. One such receptor, BT-R(1) (210 kDa), is a cadherin located in the midgut epithelium of the tobacco hornworm, Manduca sexta. It has a high binding affinity (K(d) approximately 1nM) for the Cry1A toxins of B. thuringiensis. Truncation analysis of BT-R(1) revealed that the only fragment capable of binding the Cry1A toxins of B. thuringiensis was a contiguous 169-amino acid sequence adjacent to the membrane-proximal extracellular domain. The purified toxin-binding fragment acted as an antagonist to Cry1Ab toxin by blocking the binding of toxin to the tobacco hornworm midgut and inhibiting insecticidal action. Exogenous Cry1Ab toxin bound to intact COS-7 cells expressing BT-R(1) cDNA, subsequently killing the cells. Recruitment of BT-R(1) by B. thuringiensis indicates that the bacterium interacts with a specific cell adhesion molecule during its pathogenesis. Apparently, Cry toxins, like other bacterial toxins, attack epithelial barriers by targeting cell adhesion molecules within susceptible insect hosts.

Itinerant surgical and medical specialist care in Kansas: report of a survey of rural hospital administrators.

In most rural areas, specialist nonprimary care, when available, is provided by "itinerant" physicians and surgeons who periodically visit from a distant home base. Little is known about current usage and acceptability of itinerant specialists in rural communities. Administrators of hospitals in rural and frontier Kansas counties were asked to report the frequency of itinerant care in their facilities, the home base of each specialist and a listing of procedures performed during specialist visits. Administrators were also asked to respond on a Likert scale to six questions inviting their assessment of itinerant care. Responses were received from 53 of 56 hospitals. All offered at least one monthly session of itinerant medical or surgical care. The most common specialties represented were cardiology (in 87 percent of hospitals), urology (68 percent), orthopedics (68 percent) and radiology (60 percent). General surgeons consulted in over 80 percent of responding hospitals. Psychiatrists, dermatologists and neurologists were rarely available in the hospitals surveyed. Administrators generally rated itinerant care highly, though some expressed concern about revenue lost when specialists performed procedures in their home-base office or hospital. No associations were found between amount of care offered and potential explanatory variables such as hospital size, distance from subregional centers, or percentage of patients hospitalized locally. Further study is needed to better understand differences in itinerant specialist utilization and acceptance among rural Kansas hospitals. Because Kansas demographics are similar to those of many other American rural areas, such study may offer insights applicable to other regions.

Online journals: impact on print journal usage.

PURPOSE: The research sought to determine the impact of online journals on the use of print journals and interlibrary loan (ILL). SETTING: The Library of the Health Sciences-Peoria is a regional site of the University of Illinois at Chicago (UIC) Library with a print journal collection of approximately 400 titles. Since 1999, UIC site licenses have given students and faculty affiliated with UIC-Peoria access to more than 4,000 online full-text journal titles through the Internet. METHODOLOGY: The Library of the Health Sciences-Peoria has conducted a journal-use study over an extended period of time. The information collected from this study was used to assess the impact of 104 online journals, added to the collection in January 1999, on the use of print journals. RESULTS: Results of the statistical analysis showed print journal usage decreased significantly since the introduction of online journals (F(1,147) = 12.10, P < 0.001). This decrease occurred regardless of whether a journal was available only in print or both online and in print. Interlibrary loan requests have also significantly decreased since the introduction of online journals (F(2,30) = 4.46, P < 0.02). CONCLUSIONS: The decrease in use of the print collection suggests that many patrons prefer to access journals online. The negative impact the online journals have had on the use of the journal titles available only in print suggests users may be compromising quality for convenience when selecting journal articles. Possible implications for collection development are discussed.

Information needs of rural health professionals: a review of the literature.

This review analyzes the existing research on the information needs of rural health professionals and relates it to the broader information-needs literature to establish whether the information needs of rural health professionals differ from those of other health professionals. The analysis of these studies indicates that rural health practitioners appear to have the same basic needs for patient-care information as their urban counterparts, and that both groups rely on colleagues and personal libraries as their main sources of information. Rural practitioners, however, tend to make less use of journals and online databases and ask fewer clinical questions; a difference that correlates with geographic and demographic factors. Rural practitioners experience pronounced barriers to information access including lack of time, isolation, inadequate library access, lack of equipment, lack of skills, costs, and inadequate Internet infrastructure. Outreach efforts to this group of underserved health professionals must be sustained to achieve equity in information access and to change information-seeking behaviors.

The evolving role of the librarian in evidence-based medicine.

Librarians' participation in evidence-based medicine (EBM) is rooted in past practices, most notably in clinical medical librarianship. EBM extends the librarians' role beyond identification of the literature to involvement in practicing and teaching quality filtering and critical appraisal of the literature. These activities require librarians to acquire new knowledge and develop new skills. A professional development program for librarians at the Library of the Health Sciences (LHS) at the University of Illinois at Chicago (UIC) is described. The program's goals are to increase librarians' skills and support the EBM curricular initiative at the UIC College of Medicine (COM). The unique program has been a collaborative effort of the LHS and the COM. The locally developed classes provide librarians with instruction in clinical study designs, statistical concepts, and critical appraisal of the literature. Other interventions such as an EBM round table are also described. The programs' success is measured by librarians' growing involvement in EBM medical curricula, journal clubs, and morning reports. Additionally, librarians gained competence in new skills and professional satisfaction from working collegially with COM students, residents, and faculty.

A novel group of ovarian toxicants: the psoralens.

The psoralens are naturally occurring metabolites found in many crop plants; synthetic forms of 5-methoxypsoralen (bergapten) and 8-methoxypsoralen (xanthotoxin) are widely used in skin photochemotherapy. Our previous research documented that dietary bergapten and xanthotoxin reduced birthrates in female rats when males and females were exposed to these chemicals. The present study was designed to determine the cause of this reduced birthrate and whether this resulted from direct impact on the females. The study demonstrates that bergapten and xanthotoxin administered, either alone or in combination to female rats (mated to undosed males), significantly reduced the number of implantation sites, pups, and corpora lutea in dosed females compared with control animals. Additionally, full uterine weight and empty uterine weight were significantly reduced. These compounds also significantly reduced circulating estrogen levels in a dose-dependent manner. Interestingly, the psoralens significantly induced mRNAs of liver enzymes typically induced by polycyclic aromatic hydrocarbons, CYP1A1 and UGT1A6; the higher the dose, the greater the induction. UGT 2B1 mRNA, typically induced by phenobarbital-like compounds, was not significantly affected. Thus, enhanced oxidative metabolism and conjugation of estrogens in psoralen-treated animals may provide a partial explanation for the effects observed. These findings are also consistent with psoralen-induced reduction in ovarian follicular function and ovulation.

BIOETHICSLINE use by medical students: curriculum-integrated instruction and collection development implications.

BIOETHICSLINE uselogs were analyzed during months when second-year medical students were engaged in ethics coursework that included curriculum-integrated bibliographic instruction. Uselog data showed that peak activity occurred while students were preparing a required paper. Further uselog analysis indicated that students applied database features such as controlled vocabulary, the "explode" command, and a combination of multiple search concepts. In addition, the study examined journal use and interlibrary loan activity for a correlation with online search activity. Higher bioethics journal use and interlibrary loan statistics coincided with peak BIOETHICSLINE activity periods. Citation analysis of student bibliographies reflected the interdisciplinary nature of BIOETHICSLINE and the need for ethics, legal, and clinical information sources in a bioethics collection. This study suggests that the integration of bibliographic instruction and the coordination of collection development with students' curricular needs lead to increased and more competent use of information resources.

Equalizing rural health professionals' information access: lessons from a follow-up outreach project.

A follow-up outreach project was undertaken to extend and reinforce the work of a National Library of Medicine-funded outreach project conducted in west central Illinois in 1991. The participants included five of the eight original sites as well as additional populations. An evolving partnership with the state's Center for Rural Health expanded the project's geographic area statewide. Evaluation showed benefits of varied training formats, reexposure to end-user searching, and the importance of "readiness." Follow-up training and longer trials for practice searching resulted in greater volume of search and document delivery activity. Varied training formats proved successful in reaching specific groups. Loansome Doc activity throughout the eighteen-month project suggested sustained use of Grateful Med beyond the two-month trial periods. The introduction of Grateful Med/Loansome Doc to unaffiliated health professionals is an important component in equalizing information access. Future information service initiatives are suggested to meet the challenge of building a rural information infrastructure and support system for health professionals.

Information needs of rural health professionals: a retrospective use study.

To explore the information needs of rural health professionals, a retrospective study was undertaken of 1,224 document delivery requests made during the course of three outreach projects in west and central Illinois. The 547 unique journals from which the articles were requested were analyzed for frequency of request, subject content, and inclusion on core lists. These rural health professionals were found to request current information on a wide range of topics in clinical medicine, nursing, health administration, allied health, social sciences, and basic sciences. While 10% of the titles filled 37% of the requests, 58% of the titles were requested once and filled 26% of the requests. A high correlation with Abridged Index Medicus and Brandon/Hill list titles was found, but titles from either of these lists could fill no more than 30% of the total requests. Besides demonstrating the complex information needs of rural health professionals and depicting the difficulty of building a collection to support them, the study exemplifies a method for need-based journal collection development and begins to identify titles commonly requested in a rural health setting.

Document needs in a rural GRATEFUL MED outreach project.

An analysis of documents provided to eight rural Illinois hospital sites during a GRATEFUL MED outreach project involving end-user searching revealed significant patterns that have implications for collection development and information services in small, underserved hospitals. Document requests were analyzed by user groups making the requests, subject matter, inclusion on the Brandon/Hill lists and in Abridged Index Medicus, and publication date. Of the 359 documents requested, 86% came from health professional groups other than physicians and nurses. Eighty-five percent of all requests came from two sites that had active project-trained intermediaries, with most requests forwarded by the intermediaries. Subject analysis revealed a strong need for administrative and allied health information in addition to clinical information. Fewer than half of the titles on the recommended lists were requested during the project. Most documents requested had been published in the past five years. Introduction of end-user searching is not the complete answer to improved information access at small hospitals; the authors conclude that basic collections and library personnel are still needed locally to respond effectively to health professionals' information needs.

Rural GRATEFUL MED outreach: project results, impact, and future needs.

The Library of the Health Sciences-Peoria (LHS-Peoria), located at a regional site of the University of Illinois College of Medicine, conducted an eighteen-month GRATEFUL MED outreach project funded by the National Library of Medicine. The project was designed to enhance information services for health professionals at eight underserved rural hospitals in west central Illinois. One hundred rural health professionals, mainly nonphysicians, received GRATEFUL MED training at these hospitals; LHS delivered more than 350 documents to the trainees. In this paper, investigators describe the project and its goals and discuss results and their evaluation, from both individual and institutional perspectives. Outcome is examined in the context of future outreach plans, both at LHS and elsewhere.

A multidisciplinary approach to information management and critical appraisal instruction: a controlled study.

A study of the effectiveness of a collaborative course in teaching library and critical appraisal skills was conducted at the University of Illinois College of Medicine. A critical appraisal and library skills course was taught at the Peoria site during the third-year medical clerkship. The performance of Peoria students on a twenty-item multiple choice posttest was compared to that of third-year students in Rockford, who received no library or critical appraisal instruction during their medicine clerkship. The two groups were similar in self-perceived library skills, critical appraisal skills, and other demographic values. Peoria students scored significantly higher on library, critical appraisal, and total posttest questions. An improving trend during the year was not observed at either site, implying that students were not acquiring these skills in day-to-day clerkship activities. Results suggest that this multidisciplinary course is effective in teaching library and critical appraisal skills.

The effects of pseudoephedrine on blood pressure in patients with controlled, uncomplicated hypertension: a randomized, double-blind, placebo-controlled trial.

Pseudoephedrine is frequently used as a decongestant. Because of concern about the safety of pseudoephedrine in hypertensive patients, a clinical trial was conducted to determine whether blood pressure control was actually affected by this drug in a selected group of patients with hypertension. Twenty-nine patients with controlled, uncomplicated hypertension, who received drug therapy and ranged in age from 25 to 50 years, were randomized to a treatment or a control group. Subjects took either 60 mg of pseudoephedrine or placebo capsules four times a day for 3 days. From 0800 hours until 2200 hours each day, the subjects obtained hourly blood pressure measurements using a portable sphygmomanometer. An analysis of variance with repeated measures was calculated to determine group differences for systolic and diastolic readings. No statistically or clinically significant differences were found. Therapeutic doses of pseudoephedrine did not adversely affect control of hypertension in these selected patients.