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PubMed2001

Effect of surface coatings, grain size, and ionic strength on the maximum attainable coverage of bacteria on sand surfaces.

The injection of bacteria in the subsurface has been identified as a potential method for in situ cleanup of contaminated aquifers. For high bacterial loadings, the presence of previously deposited bacteria can result in decreased deposition rates--a phenomenon known as blocking. Miscible displacement experiments were performed on short sand columns (approximately 5 cm) to determine how bacterial deposition on positively charged metal-oxyhydroxide-coated sands is affected by the presence of previously deposited bacteria. Approximately 8 pore volumes of a radiolabeled bacterial suspension at a concentration of approximately 1 x 10(9) cells ml-1 were introduced into the columns followed by a 2-pore-volume flush of cell-free buffer. It was found that the presence of Al- and Fe-coated sand increased both deposition rates and maximum fractional surface coverage of bacteria on the sediment surfaces. The effect of grain size on maximum bacterial retention capacity, however, was not significant. Decreasing ionic strength from 10(-1) to 10(-2) M KCl resulted in noticeable decreases in sticking efficiency (alpha) and maximum surface coverage (thetamax) for clean silica sand--results consistent with DLVO theory. In columns containing positively charged Al- and Fe-coated sands, however, changes in alpha and thetamax due to decreasing ionic strength were minimal. These findings demonstrate the importance of geochemical controls on the maximum bacterial retention capacity of sands.

Adsorption↗
PubMed2001

Measles vaccination in Africa: by how much could routine coverage be improved?

Assuming that the level of Bacille Calmette Guerin (BCG) coverage gives a measure of access to immunisation services, it is possible to derive what fraction of infants are not immunised against measles due to under-utilisation of existing services (rather than unavailability of services). According to the most recent official statistics, the overall coverage for measles vaccine is 53% in Africa (10% lower than for BCG). This difference amounts to 3 million African children who will not be vaccinated against measles this year even though they probably have access to immunisation services.

Africa↗
PubMed1997

The impact of vaccination strategy and methods of information on influenza and pneumococcal vaccination coverage in the elderly population.

We compared the coverage achieved with either an age-based, free-of-charge vaccination program offering influenza vaccine alone or with pneumococcal vaccine with a restricted risk disease-based influenza vaccination program supplemented by self-funded immunization. We also compared two means of informing the public, either using mailed personal reminders or through the mass media only. Forty-one administrative districts with a total of 41,500 persons aged 65 years or older participated in the study during three consecutive seasons from 1992 to 1994. The average vaccination coverage achieved by the risk disease-based program was 20%, by the age-based program with mass media information, 52%, and by the age-based program with mailed personal reminders 82%. The availability of free-of-charge vaccines is thus not sufficient to ensure a high vaccination rate. The effect of the personal reminders was restricted to the year they were sent. The addition of pneumococcal vaccine to the age-based influenza vaccination program had little influence on the acceptance rate.

Age Factors↗
PubMed1998

Assessing immunization coverage: how and why?

Assessment of immunization coverage is an important part of evaluating an immunization programme and it is a useful aid in programme management and decision making. Coverage assessment should be carried out at the national and district levels. Routine methods currently used in EU countries vary and are not always accurate, and should be validated regularly by specific surveys.

France↗
PubMed1999

Sero-epidemiology of measles antibodies in the Netherlands, a cross-sectional study in a national sample and in communities with low vaccine coverage.

Serum antibodies against measles were measured in the Dutch general population and in municipalities with low vaccine coverage, where religious groups that refuse vaccination are clustered sociogeographically. The results suggest that wild measles virus may still circulate in municipalities with low vaccine coverage; the circulation in the general population seems to have decreased significantly right after the introduction of mass vaccination. The overall prevalence in the general population was high (95.7%, 95% confidence limits 95.3-96.2%); the seroprevalence in the age groups offered two vaccinations (91.7%, 95% confidence limits 89.4-94.0%) was lower than the level believed to be necessary for the elimination of measles. Protective levels of maternal antibodies in newborns have waned several months before the first vaccination is scheduled.

Adolescent↗
PubMed2002

Use of the medial adipofascial flap of the leg for coverage of full-thickness burns exposing the tibial crest.

Bone exposure constitutes a frequent and difficult problem in burn patients. Where free flaps remain indicated in tibial osteomyelitis, a pedicled fascial or adipofascial flap provides an excellent alternative for coverage of simple tibial crest exposure. In fact, the adipofascial tissue of the anteromedial aspect of the leg can be mobilized over the whole length of the tibia. It is vascularized by the saphenous artery and the posterior tibial artery perforators. This pattern of blood supply allows a wide range of use for any size of burn defect in this area. Therefore, this local pedicled flap provides an excellent solution for coverage of the exposed tibia after severe burns.

Burns↗
PubMed2000

Cultured epithelial autografts in extensive burn coverage of severely traumatized patients: a five year single-center experience with 30 patients.

OBJECTIVE: We report recent five-year experience in a large, single center series of severely burned and otherwise traumatized patients given cultured epithelial autografts (CEA) from a single commercial laboratory. SUMMARY BACKGROUND DATA: Initial optimism over CEA application has been tempered by subsequent reports asserting that this modality is unreliable and expensive. Discussion continues over its clinical role. METHODS: From 1991 to 1996, CEA were applied to a mean 37+/-17% of total body surface area (TBSA) of 30 patients. These patients had 78+/-10% average burn size, 65+/-16% average third-degree burn size, 90% prevalence of endoscopically confirmed inhalation injury and 37% prevalence of other serious conditions. RESULTS: CEA achieved permanent coverage of a mean 26+/-15% of TBSA, an area greater than that covered by conventional autografts (a mean 25+/-10% of TBSA). Survival was 90% in these severely burned and otherwise traumatized patients. Final CEA take was a mean 69+/-23%. In subset analyses, only younger age was significantly associated with better CEA take (p = 0.0001 in univariate analysis, p<0.04 in multivariate analysis, Student's t-test). CONCLUSIONS: Epicel CEA successfully provided extensive, permanent burn coverage in severely traumatized patients, proving an important adjunct to achievement of a high survival rate in a patient population whose prognosis previously had been poor. In our experience CEA appear to have a very high beneficial value in the management of bur ns >60% TBSA. In some cases studied it is very likely that CEA was a life-saving treatment.

Adolescent↗
PubMed2003

Assessment of different IMRT boost delivery methods on target coverage and normal-tissue sparing.

PURPOSE: Because of biologic, medical, and sometimes logistic reasons, patients may be treated with 3D conformal therapy or intensity-modulated radiation therapy (IMRT) for the initial treatment volume (PTV(1)) followed by a sequential IMRT boost dose delivered to the boost volume (PTV(2)). In some patients, both PTV(1) and PTV(2) may be simultaneously treated by IMRT (simultaneous integrated boost technique). The purpose of this work was to assess the sequential and simultaneous integrated boost IMRT delivery techniques on target coverage and normal-tissue sparing. MATERIALS AND METHODS: Fifteen patients with head-and-neck (H&N), lung, and prostate cancer were selected for this comparative study. Each site included 5 patients. In all patients, the target consisted of PTV(1) and PTV(2). The prescription doses to PTV(1) and PTV(2) were 46 Gy and 66 Gy (H&N cases), 45 Gy and 66.6 Gy (lung cases), 50 Gy and 78 Gy (prostate cases), respectively. The critical structures included the following: spinal cord, parotid glands, and brainstem (H&N structures); spinal cord, esophagus, lungs, and heart (lung structures); and bladder, rectum, femurs (prostate structures). For all cases, three IMRT plans were created: (1) 3D conformal therapy to PTV(1) followed by sequential IMRT boost to PTV(2) (sequential-IMRT(1)), (2) IMRT to PTV(1) followed by sequential IMRT boost to PTV(2) (sequential-IMRT(2)), and (3) Simultaneous integrated IMRT boost to both PTV(1) and PTV(2) (SIB-IMRT). The treatment plans were compared in terms of their dose-volume histograms, target volume covered by 100% of the prescription dose (D(100%)), and maximum and mean structure doses (D(max) and D(mean)). RESULTS: H&N cases: SIB-IMRT produced better sparing of both parotids than sequential-IMRT(1), although sequential-IMRT(2) also provided adequate parotid sparing. On average, the mean cord dose for sequential-IMRT(1) was 29 Gy. The mean cord dose was reduced to approximately 20 Gy with both sequential-IMRT(2) and SIB-IMRT. Prostate cases: The volume of rectum receiving 70 Gy or more (V(>70 Gy)) was reduced to 18.6 Gy with SIB-IMRT from 22.2 Gy with sequential-IMRT(2). SIB-IMRT reduced the mean doses to both bladder and rectum by approximately 10% and approximately 7%, respectively, as compared to sequential-IMRT(2). The mean left and right femur doses with SIB-IMRT were approximately 32% lower than obtained with sequential-IMRT(1). Lung cases: The mean heart dose was reduced by approximately 33% with SIB-IMRT as compared to sequential-IMRT(1). The mean esophagus dose was also reduced by approximately 10% using SIB-IMRT as compared to sequential-IMRT(1). The percentage of the lung volume receiving 20 Gy (V(20 Gy)) was reduced to 26% by SIB-IMRT from 30.6% with sequential-IMRT(1). CONCLUSIONS: For equal PTV coverage, both sequential-IMRT techniques demonstrated moderately improved sparing of the critical structures. SIB-IMRT, however, markedly reduced doses to the critical structures for most of the cases considered in this study. The conformality of the SIB-IMRT plans was also much superior to that obtained with both sequential-IMRT techniques. The improved conformality gained with SIB-IMRT may suggest that the dose to nontarget tissues will be lower.

Head and Neck Neoplasms↗
PubMed1982

The pectoralis major island flap for coverage in the upper extremity.

From July 1, 1978, to July 1, 1980, 26 patients required pedicle flap coverage for acute skin loss defects in the hand and upper extremity. Eighteen patients had groin or abdominal flap coverage, and the pectoralis major island flap (PMIF) was used in eight patients. The circumstances of injury were approximately the same in both groups, consisting of a gunshot wound or electrical injury in over half of the cases. The PMIF was selected more often in proximal and dorsal injuries of the forearm and wrist and in older patients. Two of 13 groin flaps sustained partial necrosis, but none of the abdominal or PMIF flaps necrosed. The principle advantages of the PMIF in these selected cases was fourfold: (1) an extremity placed in a less dependent, sling-like position, (2) mobility, (3) reliability, and (4) a complete inset into the defect. The chest wall donor site defect, however, must be given some consideration.

Abdomen↗
PubMed2003

Soft tissue coverage in devastating hand injuries.

Plastic surgical therapy of mutilating hand injuries represents a multifaceted task to the hand surgeon, where considerations about indication, timing, and structure of the soft tissue coverage play a major role in reconstruction. The concept of early primary reconstruction (including emergency procedures) and fast rehabilitation not only demands thoughtful tissue preparation but also mastering of a bandwidth of plastic surgical techniques. Systematic algorithms based on the reconstructive ladder help in decision making in the complexity of soft tissue coverage but have to be adjusted to the individual case profile. General considerations and strategic planning are explained and illustrated by three clinical cases.

Adult↗
PubMed2000

The impact of computer-generated messages on childhood immunization coverage(2)(2)

Introduction: Recent evaluations of computer-generated reminder/recall messages have suggested that they are an inexpensive, labor-saving method of improving office visitation rates of childhood immunization providers. This study assesses the sustained impact of computer-generated messages on immunization coverage during the first two years of life.Design: Randomized, controlled trial.Setting: County health department in the Denver metropolitan area.Study Participants: Children (n = 1227) 60 to 90 days of age who had received the first dose of diphtheria-tetanus-pertussis (DTP) and/or poliovirus vaccines.Intervention: Households of children were randomized into four groups to receive: telephone messages followed by letters (Group A); telephone messages alone (Group B); letters only (Group C); or no notification (Group D). Households in the intervention groups (A, B, and C) received up to five computer-generated telephone messages and/or up to four letters each time their children became due for immunization(s).Main Outcome Measure: Immunization series completion at 24 months of age.Results: Children whose families were randomized to receive any of the interventions were 21% more likely to have completed the immunization series by 24 months of age than were children randomized into the control group (49.2% vs 40.9%; RR [rate ratio] = 1.21; CI [confidence interval] =1.01, 1.44). While not statistically significant, children in Group A were 23% more likely to complete their immunization series by 24 months of age than those in the control group (50.2% vs 40.9%; RR = 1.23; CI = 1.00, 1.52). No differences were detected among the intervention groups. The costs per additional child completing the series by 24 months of age in Group A was $226 ($79 after start-up costs were discounted). Conclusion: Computer-generated contacts, either by phone or by mail (or both combined), used each time vaccines become due, are efficacious in increasing immunization coverage of children under 2 years of age.

Journal Article↗
PubMed2000

The impact of computer-generated messages on childhood immunization coverage.

INTRODUCTION: Recent evaluations of computer-generated reminder/recall messages have suggested that they are an inexpensive, labor-saving method of improving office visitation rates of childhood immunization providers. This study assesses the sustained impact of computer-generated messages on immunization coverage during the first two years of life. DESIGN: Randomized, controlled trial. SETTING: County health department in the Denver metropolitan area. STUDY PARTICIPANTS: Children (n = 1227) 60 to 90 days of age who had received the first dose of diphtheria-tetanus-pertussis (DTP) and/or poliovirus vaccines. INTERVENTION: Households of children were randomized into four groups to receive: telephone messages followed by letters (Group A); telephone messages alone (Group B); letters only (Group C); or no notification (Group D). Households in the intervention groups (A, B, and C) received up to five computer-generated telephone messages and/or up to four letters each time their children became due for immunization(s). MAIN OUTCOME MEASURE: Immunization series completion at 24 months of age. RESULTS: Children whose families were randomized to receive any of the interventions were 21% more likely to have completed the immunization series by 24 months of age than were children randomized into the control group (49.2% vs 40.9%; RR [rate ratio] = .21; CI [confidence interval] = 1.01, 1.44). While not statistically significant, children in Group A were 23% more likely to complete their immunization series by 24 months of age than those in the control group (50.2% vs 40.9%; RR = 1.23; CI = 1.00, 1.52). No differences were detected among the intervention groups. The costs per additional child completing the series by 24 months of age in Group A was $226 ($79 after start-up costs were discounted). CONCLUSION: Computer-generated contacts, either by phone or by mail (or both combined), used each time vaccines become due, are efficacious in increasing immunization coverage of children under 2 years of age.

Child Health Services↗
PubMed2002

Extracranial stereotactic radiotherapy: evaluation of PTV coverage and dose conformity.

During the past few years the concept of cranial stereotactic radiotherapy has been successfully extended to extracranial tumoral targets. In our department, hypofractionated treatment of tumours in lung, liver, abdomen, and pelvis is performed in the Stereotactic Body Frame (ELEKTA Instrument AB) since 1997. We present the evaluation of 63 consecutively treated targets (22 lung, 21 liver, 20 abdomen/pelvis) in 58 patients with respect to dose coverage of the planning target volume (PTV) as well as conformity of the dose distribution. The mean PTV coverage was found to be 96.3% +/- 2.3% (lung), 95.0% +/- 4.5% (liver), and 92.1% +/- 5.2% (abdomen/pelvis). For the so-called conformation number we obtained values of 0.73 +/- 0.09 (lung), 0.77 +/- 0.10 (liver), and 0.70 +/- 0.08 (abdomen/pelvis). The results show that highly conformal treatment techniques can be applied also in extracranial stereotactic radiotherapy. This is primarily due to the relatively simple geometrical shape of most of the targets. Especially lung and liver targets turned out to be approximately spherically/cylindrically shaped, so that the dose distribution can be easily tailored by rotational fields.

Abdominal Neoplasms↗
PubMed1998

Organised cervical cancer screening still leads to higher coverage than spontaneous screening in The Netherlands.

In The Netherlands, early detection of cervical cancer by programme and spontaneous screening has been common practice for more than two decades. Both types of screening are mainly performed by general practitioners. Therefore, the question is raised of whether programme screening still enhances screening uptake. To answer this question, we analysed the national health interview survey in the years 1992-1996. The coverage rate, defined as the percentage of women with at least one smear taken in the previous 5 years, was 91% for women invited for programme screening compared with 68% for women not invited. The performance of the organised programme in reducing excessive screening, i.e. smears taken in excess of the recommended age and interval range, was not clear and the effect seemed small. Furthermore, we found that half the non-attenders were 'protected' by a recent smear or a hysterectomy, and of the unprotected women, 72% showed a positive attitude towards the programme. We conclude that even after a long history of cervical cancer screening, an organised programme is still required to ensure a high coverage.

Adult↗
PubMed2003

Exploiting the complementary nature of LC/MALDI/MS/MS and LC/ESI/MS/MS for increased proteome coverage.

The goal of this work was to evaluate the improvement in proteome coverage of complex protein mixtures gained by analyzing samples using both LC/ESI/MS/MS and LC/MALDI/MS/MS. Parallel analyses of a single sample were accomplished by interfacing a Probot fractionation system with a nanoscale LC system. The Probot was configured to perform a post-column split such that a fraction (20%) of the column effluent was sent for on-line LC/ESI/MS/MS data acquisition, and the majority of the sample (80%) was mixed with a matrix solution and deposited onto the MALDI target plate. The split-flow approach takes advantage of the concentration sensitive nature of ESI and provides sufficient quantity of sample for MALDI/MS/MS. Hybrid quadrupole time-of-flight mass spectrometers were used to acquire LC/ESI/MS/MS data and LC/MALDI/MS/MS data from a tryptic digest of a preparation of mammalian mitochondrial ribosomes. The mass spectrometers were configured to operate in a data dependent acquisition mode in which precursor ions observed in MS survey scans are automatically selected for interrogation by MS/MS. This type of acquisition scheme maximizes the number of peptide fragmentation spectra obtained and is commonly referred to as shotgun analysis. While a significant degree of overlap (63%) was observed between the proteins identified in the LC/ESI/MS/MS and LC/MALDI/MS/MS data sets, both unique peptides and unique proteins were observed by each method. These results demonstrate that improved proteome coverage can be obtained using a combination of these ionization techniques.

Animals↗
PubMed2000

Immunization coverage among predominantly Hispanic children, aged 2-3 years, in central Los Angeles.

PURPOSE: To assess the immunization status of young children in a predominantly Hispanic region in and around downtown Los Angeles, and factors associated with complete immunization by age 24 months. METHODS: The information was gathered in a two-stage cluster survey with probability proportionate to estimated size (PPS) sampling of 30 clusters at the first stage, and simple random sampling of a constant number of children at the second stage. Vaccination coverage was determined by a review of the home immunization (HI) card, or of clinic records. RESULTS: Of the 270 sampled children, 91.5% were Hispanic and 6.7% were Black. Home telephone numbers were not available in 24.8% of the homes, and 34.1% reported having no health insurance. Vaccination coverage was over 90% for the first three doses of Diphtheria, tetanus toxoids and pertussis/ diphtheria, tetanus toxoids and acellular pertussis vaccine (DTP/DTaP)/Diphtheria and tetanus toxoids vaccine (DT), first two doses of poliovirus (Polio) vaccine, first dose of measles, mumps and rubella (MMR) vaccine, and first two doses of hepatitis B (Hep B) vaccine. Yet, by age 24 months, only 72.2% of the children had received the combined series of 4:3:1 (i.e., four DTP/DTaP/DT, three Polio, one MMR). This was further reduced to 64.4% for the combined series of 4:3:1:3:3 (i.e., four DTP/DTaP/ DT, three Polio, one MMR, three Haemophilus influenzae type b (Hib), three Hep B). Factors associated with completed on-time vaccination were having an HI card available during the interview and being enrolled in Supplemental Nutrition Program for Women, Infants and Children (WIC). CONCLUSIONS: While vaccination levels for individual antigens were found to be high, more emphasis needs to be placed on getting preschool children vaccinated on-time according to the Recommended Childhood Immunization Schedule.

Child, Preschool↗
PubMedDate not supplied

Latissimus dorsi pedicle flap for coverage of soft tissue defects about the elbow.

Sixteen consecutive patients who were treated with a pedicled latissimus dorsi flap for complex soft tissue defects about the elbow were reviewed. The average defect size was 100 cm2. Thirteen of the 16 patients achieved stable wound healing with a single procedure. Three patients had partial necrosis of the latissimus and required additional coverage procedures. We recommend that the latissimus dorsi flap should not be routinely used to cover defects more than 8 cm distal to the olecranon. The flap should be closely monitored in the first 48 hours, drains should be routinely used at the recipient and donor sites, and the elbow should be maintained in an extended position for the first 5 days after the procedure. The latissimus dorsi flap may also have a prophylactic role in selected patients with compromised soft tissue coverage about the elbow. The pedicled latissimus flap can be performed under loupe magnification and requires no microsurgical skills or equipment.

Adolescent↗
PubMedDate not supplied

Lateral calcaneal artery flap for coverage of a posterior heel defect in a child.

The lateral calcaneal artery fasciocutaneous transpositional flap is utilized for coverage in a case presentation of a 6-year-old child with an insensate posterior heel defect. The procedural technique and 32-month follow-up is described. Advocacy of this flap, for this patient, and potential detriments of alternative coverage options are discussed.

Child↗