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Purpose This study aims to report on a series of “essential audits” implemented by technical services personnel at Georgia Southern University to provide proactive troubleshooting of electronic resources. Design/methodology/approach These “essential audits” include bi-weekly link tests in the library’s A-Z database list, quarterly book and link asset tests in LibGuides and rolling authentication audits of link resolver records. Taken together, these techniques help to reduce access issues before they arise, improving overall provision of access. Findings Since implementing these “essential audits,” Georgia Southern has seen reductions in troubleshooting requests related to database-level authentication and access, as well as reductions in link-level troubleshooting requests originating from the library’s LibGuides platform and article-level troubleshooting requests originating from the link resolver. Practical implications Findings recommend implementation of regular audits pursuant to proactive troubleshooting of electronic resources and improved overall provision of access. Originality/value This case study contributes to the recent literature and discourse on electronic resource access troubleshooting by highlighting simple, proactive auditing techniques.

Background Little is known about effective at-home oral care methods for people with developmental disabilities (DDs) who are unable to perform personal preventive practices themselves and rely on caregivers for assistance.

OBJECTIVES: To compare the demographic and geographic patterns of pneumonia and influenza (P&I) hospitalizations in older adults with dementia with those of the U.S. population and to examine the relationship between healthcare accessibility and P&I. DESIGN: Observational study using historical medical claims from the Centers for Medicare and Medicaid Services (CMS) and CMS records supplemented with information derived from other large national sources. SETTING: Retrospective analysis of medical records uniformly collected over a 5-year period with comprehensive national coverage. PARTICIPANTS: A study population representative of more than 95% of all people aged 65 and older residing in the continental United States. MEASUREMENTS: Six million two hundred seventy-seven thousand six hundred eighty-four records of P&I between 1998 and 2002 were abstracted, and county-specific outcomes for hospitalization rates of P&I, mean length of hospital stay, and percentage of deaths occurring in a hospital setting were estimated. Associations with county-specific elderly population density, percentage of nursing home residents, median household income per capita, and rurality index were assessed. RESULTS: Rural and poor counties had the highest rate of P&I and percentage of influenza. Patients with dementia had a lower frequency of influenza diagnosis, a shorter length of hospital stay, and 1.5 times as high a rate of death as the national average. CONCLUSION: The results suggest strong disparities in healthcare practices in rural locations and vulnerable populations; infrastructure, proximity, and access to healthcare are significant predictors of influenza morbidity and mortality. These findings have important implications for influenza vaccination, testing, and treatment policies and practices targeting the growing fraction of patients with cognitive impairment.

According to the 2008 American Community Survey, about 12% of the population of the United States is living with one or more disabling conditions. These conditions impact lives in a variety of ways, some with more or less direct impact on an individual's health and access to health care services. Although it has been 20 years since the passage of the Americans with Disabilities Act, people with disabilities still experience health disparities and a lack of access to the appropriate care. This commentary is part of a collection of articles that describe various aspects of incorporating content into the medical school curriculum to enhance the preparation of today's medical students to meet the needs of people with disabilities. The authors briefly describe the scope of the problem and define the population of people with disabilities that constitutes the focus of the work described in the other articles in this collection.

Little is known about effective at-home oral care methods for people with developmental disabilities (DDs) who are unable to perform personal preventive practices themselves and rely on caregivers for assistance.A convenience sample of 808 caregivers (84.5 percent paid, 15.5 percent family members) who accompanied adults with DDs (20 years or older) to appointments at a specialized statewide dental care system completed computer-assisted personal interview surveys. The authors used these data to investigate caregivers' at-home oral care experiences and to explore differences between caregivers who were paid and those who were family members.Caregivers reported that a high proportion (85 percent) of dentate adults with DDs received assistance with tooth cleaning. They also reported a high prevalence of dental problems, and low adherence to brushing (79 percent) and flossing (22 percent) recommendations. More caregivers reported that they felt confident assisting with brushing than with flossing (85 percent versus 54 percent). Family members and paid caregivers differed with respect to confidence and training.At-home oral care, particularly flossing, presents substantial challenges for adults with DDs. Solutions must be tailored to address the different experiences and distinct needs of the family members and paid caregivers who assist these adults.Caregivers play an important role in providing at-home oral care, and they must be included in efforts to improve oral health outcomes for people with DDs.

BACKGROUND Vitrectomy and gas tamponade has become a recognised technique for the treatment of macular holes. In an attempt to improve the anatomic and visual success of the procedure, various adjunctive therapies—cytokines, serum, and platelets—have been employed. A consecutive series of 85 eyes which underwent macular hole surgery using gas tamponade alone, or gas tamponade with either the cytokine transforming growth factor β2 (TGF-β2) or autologous platelet concentrate is reported. METHODS Twenty eyes had vitrectomy and 20% SF 6 gas tamponade; 15 had vitrectomy, 20% SF 6 gas, and TGF-β2; 50 had vitrectomy, 16% C 3 F 8 gas tamponade, and 0.1 ml of autologous platelet concentrate prepared during the procedure. RESULTS Anatomic success occurred in 86% of eyes, with 96% of the platelet treated group achieving closure of the macular hole. Visual acuity improved by two lines or more in 65% of the SF 6 only group, 33% of those treated with TGF-β2, and in 74% of the platelet treated group. In the platelet treated group 40% achieved 6/12 or better and 62% achieved 6/18 or better. The best visual results were obtained in stage 2 holes. CONCLUSION Vitrectomy for macular holes is often of benefit and patients may recover good visual acuity, especially early in the disease process. The procedure has a number of serious complications, and the postoperative posturing requirement is difficult. Patients need to be informed of such concerns before surgery.

Two reports by the U.S. surgeon general noted the disproportionate impact of oral disease on and lack of oral health information regarding people with disabilities.In this retrospective study, the authors used clinical and demographic data (from April 1, 2009, through March 31, 2010) from electronic dental records of 4,732 adults with intellectual and developmental disabilities (IDDs) who were receiving dental care through a state-supported system of dental clinics. The authors used these data to investigate the oral health status of, and associated risk factors for, adults with IDD.The prevalence of untreated caries in the study population was 32.2 percent, of periodontitis was 80.3 percent and of edentulism was 10.9 percent. The mean (standard deviation) numbers of decayed teeth; missing teeth; and decayed, missing and filled teeth were 1.0 (2.2), 6.7 (7.0) and 13.9 (7.7), respectively.Management of oral health presents significant challenges in adults with IDD. Age, ability to cooperate with dental treatment and type of residence are important considerations in identifying preventive strategies.The study population demonstrated a high burden of dental disease. Further research is required to identify effective interventions to improve oral health in adults with IDD.

Standardized patients (SPs), now a mainstay of the undergraduate medical education experience, are beginning to play larger roles in helping students build competencies to better serve patients who have disabilities, in educating students about the lived experiences of persons with disabilities, and in testing students' understanding of disability-related issues. In this article, the authors discuss several U.S. training programs that involve SPs who have disabilities or SPs who do not have disabilities but who portray patients who do. The authors review the goals of each program (e.g., to provide students with opportunities to gain experience with patients with disabilities), describe their commonalities (enhancing students' interview skills) and differences (some programs are educational; some are evaluative), and summarize the evaluative data of each. The authors also explore the benefits and challenges of working with SPs with disabilities and of working with SPs without disabilities. Finally, they consider the practical issues (e.g., recruiting SPs) of developing and implementing such programs.

The problems adults with disabilities face obtaining quality primary care services are persistent and undermine national efforts to improve the health status of this group. Efforts to address this issue by providing disability-related training to physicians are hampered by limited information about what generalist physicians need to know to care for patients with disabilities. The authors consider the desired outcomes of disability-related training for generalists by exploring the contributions of the domains of knowledge, attitudes, and skills to patient-directed behavior and summarizing the empirical data.Because disability reflects a complex interplay among individual, interpersonal, institutional, community, and societal factors, generalist physicians can promote and protect the health of adults with disabilities by interventions at multiple levels. Thus, the authors use the social-ecological framework, an approach to health promotion that recognizes the complex relationships between individuals and their environments, to delineate the recommended knowledge, attitudes, and skills in the context of primary care. The importance of role models who demonstrate the three domains, the interactions among them, and issues in evaluation are also discussed. This clear delineation of the recommended educational outcomes of disability-related training in terms of knowledge, attitudes, and skills will support efforts to better prepare generalist physicians-in training and in practice-to care for adults with disabilities and to evaluate these training strategies.

Adequate health services are critical to the success of efforts to maintain persons with mental retardation in the community, yet information concerning the health status of this population is in short supply. This paper presents the results of a survey of 333 mentally retarded persons randomly selected from a population of 1,333 such individuals living in community settings. Almost two-thirds had chronic conditions requiring medical intervention. The top five conditions in terms of prevalence were neurologic, ophthalmologic, dermatologic, psychiatric-emotional, and orthopedic. The majority of conditions were being managed appropriately in the community health system. A substantial proportion can be managed by primary care physicians with limited specialty involvement. For almost 60 percent of clients with conditions requiring home treatments on an ongoing basis, however, service gaps were identified. Other problems included the reluctance of some providers to accept Medicaid, and the inability of some clients to cooperate with medical examinations.

Background: Multiple identical sets of sera from cancer cases and controls would facilitate standardized testing of biomarkers. We describe the creation and use of standard serum sets developed from healthy donors and pooled sera from ovarian, breast, and endometrial cancer cases. Methods: Two hundred seventy-five 0.3-mL aliquots of sera were created for each of the 95 healthy women, and residual serum was pooled to create 275 identical sets of 20 0.3-mL aliquots. Aliquots (1.0-1.5 mL) from 441 women were combined to create 12 breast and pelvic disease pools with at least 115 0.3-mL aliquots. Sets were assembled to contain aliquots from individual controls, replicates, and disease pools. Cancer antigens (CA), CA 125, CA 19.9, and CA 15.3, and carcinoembryonic antigen were measured in one set and in 217 women comprising six of the pelvic disease pools. Use of a set was illustrated for mesothelin (soluble mesothelin-related protein). Statistical output included concentration differences between pooled cases and controls (z values for single analytes; Mahalanobis distances for pairs), correlation between z values and sensitivities, coefficient of variations, and standardized biases. Results: Marker concentrations in the six pelvic disease pools were generally within 0.25 SD of the actual average, and z values correlated well with sensitivities. CA 125 remains the best single marker for nonmucinous ovarian cancer, complemented by CA 15.3 or soluble mesothelin-related protein. There is no comparable breast cancer biomarker among the current analytes tested. Conclusion: The potential value of standard serum sets for initial assessment of candidate biomarkers is illustrated. Sets are now available through the Early Detection Research Network to evaluate biomarkers for women's cancers. (Cancer Epidemiol Biomarkers Prev 2007;16(2):334–41)

Editor,—Ocular toxoplasmosis is the most frequent infectious cause of chorioretinal inflammation in immunocompetent individuals.1 Diagnosis is usually made by observing the typical fundus lesion, by detecting the presence of anti- Toxoplasma antibodies in the serum, and by excluding other causes of necrotising fundus lesions.2In unusual cases, invasive procedures may be required to aid diagnosis.3 ### CASE REPORT A 17 year old white male presented complaining of floaters and reduced visual acuity in the left eye. Visual acuity was 6/9 in the left eye, 6/6 in the right. Examination revealed moderate anterior chamber activity, marked vitritis, and an active retinochoroiditis adjacent to an area of old chorioretinal scarring inferonasal to the optic disc. A diagnosis of ocular toxoplasmosis was suspected, and topical and oral steroids, …

Smoking policies and smoking practices of residents and employees in a state-supported residential system were investigated. Smoking policies existed in almost every agency, although state- and vendor-operated programs had vastly different policies. State-operated programs prohibited employees from smoking in residences and restricted residents who smoked to designated areas. One third of vendor-operated agencies allowed residents and staff members to smoke in designated areas, whereas one quarter stipulated that residences be smoke-free. Smoking among employees was higher and among residents lower than in the general population. The feasibility of specific approaches to reduce passive smoking and attitudes and beliefs about human rights issues related to smoking are presented.

Smoking policies and smoking practices of residents and employees in a state-supported residential system were investigated. Smoking policies existed in almost every agency, although state- and vendor-operated programs had vastly different policies. State-operated programs prohibited employees from smoking in residences and restricted residents who smoked to designated areas. One third of vendor-operated agencies allowed residents and staff members to smoke in designated areas, whereas one quarter stipulated that residences be smoke-free. Smoking among employees was higher and among residents lower than in the general population. The feasibility of specific approaches to reduce passive smoking and attitudes and beliefs about human rights issues related to smoking are presented.

Conflicting legal, administrative, and professional policies surround family involvement in the deinstitutionalization process. This article addresses these discrepancies and makes recommendations for developing effective and consistent channels of policy among social workers and other helping professionals.

This study assessed the need for physician services among a group of institutionalized mentally retarded individuals in anticipation of their transfer to community residential facilities and subsequent management of their care by community-based physicians. The clients' personal physicians in the institution identified every chronic condition which required physician services, and recommended the kind of physician and frequency of visits for the management of each condition. Key informants reviewed these estimates and determined if there were sufficient physicians in their communities to provide this care. Thirty-two per cent of the conditions but only 8 per cent of the clients could be managed by a primary care physician. The most frequently required specialties were neurology, orthopedics, and ophthalmology. While primary care services and many of the necessary specialty services were available in the community to meet the needs of these individuals, several specialties essential to the medical care of this group were not available. These included orthopedics for the multiply-handicapped, neurology including behavioral neurology, and psychiatry. Deinstitutionalization policies which rely solely upon community physician services will lead to inadequate medical care in the community for some mentally retarded individuals. In these situations, alternative approaches to care must be developed.