Delays in childhood immunization in a conflict area: a study from Sierra Leone during civil war

ABSTRACT: BACKGROUND: Sierra Leone has undergone a decade of civil war from 1991 to 2001. From this period few data on immunization coverage are available, and conflict-related delays in immunization according to the Expanded Programme on Immunization (EPI) schedule have not been investigated. We aimed to study delays in childhood immunization in the context of civil war in a Sierra Leonean community. METHODS: We conducted an immunization survey in Kissy Mess-Mess in the Greater Freetown area in 1998/99 using a two-stage sampling method. Based on immunization cards and verbal history we collected data on immunization for tuberculosis, diphtheria, tetanus, pertussis, polio, and measles by age group (0-8/9-11/12-23/24-35 months). We studied differences between age groups and explored temporal associations with war-related hostilities taking place in the community. RESULTS: We included 286 children who received 1690 vaccine doses; card retention was 87%. In 243 children (85%, 95% confidence interval (CI): 80-89%) immunization was up-to-date. In 161 of these children (56%, 95%CI: 50-62%) full age-appropriate immunization was achieved; in 82 (29%, 95%CI: 24-34%) immunization was not appropriate for age. In the remaining 43 children immunization was partial in 37 (13%, 95%CI: 9-17) and absent in 6 (2%, 95%CI: 1-5). Immunization status varied across age groups. In children aged 9-11 months the proportion with age-inappropriate (delayed) immunization was higher than in other age groups suggesting an association with war-related hostilities in the community. CONCLUSION: Only about half of children under three years received full age-appropriate immunization. In children born during a period of increased hostilities, immunization was mostly inappropriate for age, but recommended immunizations were not completely abandoned. Missing or delayed immunization represents an additional threat to the health of children living in conflict areas.

Diagnostic criteria for hematopoietic stem cell transplant-associated microangiopathy: results of a consensus process by an International Working Group

BACKGROUND AND OBJECTIVES: There are no widely accepted criteria for the definition of hematopoietic stem cell transplant -associated microangiopathy (TAM). An International Working Group was formed to develop a consensus formulation of criteria for diagnosing clinically significant TAM. DESIGN AND METHODS: The participants proposed a list of candidate criteria, selected those considered necessary, and ranked those considered optional to identify a core set of criteria. Three obligatory criteria and four optional criteria that ranked highest formed a core set. In an appropriateness panel process, the participants scored the diagnosis of 16 patient profiles as appropriate or not appropriate for TAM. Using the experts' ratings on the patient profiles as a gold standard, the sensitivity and specificity of 24 candidate definitions of the disorder developed from the core set of criteria were evaluated. A nominal group technique was used to facilitate consensus formation. The definition of TAM with the highest score formed the final PROPOSAL. RESULTS: The Working Group proposes that the diagnosis of TAM requires fulfilment of all of the following criteria: (i) >4% schistocytes in blood; (ii) de novo, prolonged or progressive thrombocytopenia (platelet count <50 x 109/L or 50% or greater reduction from previous counts); (iii) sudden and persistent increase in lactate dehydrogenase concentration; (iv) decrease in hemoglobin concentration or increased transfusion requirement; and (v) decrease in serum haptoglobin. The sensitivity and specificity of this definition exceed 80%. INTERPRETATION AND CONCLUSIONS: The Working Group recommends that the presented criteria of TAM be adopted in clinical use, especially in scientific trials.

Guidelines for the use and interpretation of assays for monitoring autophagy in higher eukaryotes

Research in autophagy continues to accelerate,(1) and as a result many new scientists are entering the field. Accordingly, it is important to establish a standard set of criteria for monitoring macroautophagy in different organisms. Recent reviews have described the range of assays that have been used for this purpose.(2,3) There are many useful and convenient methods that can be used to monitor macroautophagy in yeast, but relatively few in other model systems, and there is much confusion regarding acceptable methods to measure macroautophagy in higher eukaryotes. A key point that needs to be emphasized is that there is a difference between measurements that monitor the numbers of autophagosomes versus those that measure flux through the autophagy pathway; thus, a block in macroautophagy that results in autophagosome accumulation needs to be differentiated from fully functional autophagy that includes delivery to, and degradation within, lysosomes (in most higher eukaryotes) or the vacuole (in plants and fungi). Here, we present a set of guidelines for the selection and interpretation of the methods that can be used by investigators who are attempting to examine macroautophagy and related processes, as well as by reviewers who need to provide realistic and reasonable critiques of papers that investigate these processes. This set of guidelines is not meant to be a formulaic set of rules, because the appropriate assays depend in part on the question being asked and the system being used. In addition, we emphasize that no individual assay is guaranteed to be the most appropriate one in every situation, and we strongly recommend the use of multiple assays to verify an autophagic response.

Application of well log tomography to the Dundee and Rogers City Limestones, Michigan Basin, USA

The Michigan Basin is located in the upper Midwest region of the United States and is centered geographically over the Lower Peninsula of Michigan. It is filled primarily with Paleozoic carbonates and clastics, overlying Precambrian basement rocks and covered by Pleistocene glacial drift. In Michigan, more than 46,000 wells have been drilled in the basin, many producing significant quantities of oil and gas since the 1920s in addition to providing a wealth of data for subsurface visualization. Well log tomography, formerly log-curve amplitude slicing, is a visualization method recently developed at Michigan Technological University to correlate subsurface data by utilizing the high vertical resolution of well log curves. The well log tomography method was first successfully applied to the Middle Devonian Traverse Group within the Michigan Basin using gamma ray log curves. The purpose of this study is to prepare a digital data set for the Middle Devonian Dundee and Rogers City Limestones, apply the well log tomography method to this data and from this application, interpret paleogeographic trends in the natural radioactivity. Both the Dundee and Rogers City intervals directly underlie the Traverse Group and combined are the most prolific reservoir within the Michigan Basin. Differences between this study and the Traverse Group include increased well control and “slicing” of a more uniform lithology. Gamma ray log curves for the Dundee and Rogers City Limestones were obtained from 295 vertical wells distributed over the Lower Peninsula of Michigan, converted to Log ASCII Standard files, and input into the well log tomography program. The “slicing” contour results indicate that during the formation of the Dundee and Rogers City intervals, carbonates and evaporites with low natural radioactive signatures on gamma ray logs were deposited. This contrasts the higher gamma ray amplitudes from siliciclastic deltas that cyclically entered the basin during Traverse Group deposition. Additionally, a subtle north-south, low natural radioactive trend in the center of the basin may correlate with previously published Dundee facies tracts. Prominent trends associated with the distribution of limestone and dolomite are not observed because the regional range of gamma ray values for both carbonates are equivalent in the Michigan Basin and additional log curves are needed to separate these lithologies.

Multimembership and Identity in Writing Centers and in Industry: Examining the Work of Reconciliation in the Michigan Tech Multiliteracies Center and at Kimberly-Clark Corporation

Writing center scholarship and practice have approached how issues of identity influence communication but have not fully considered ways of making identity a key feature of writing center research or practice. This dissertation suggests a new way to view identity -- through an experience of "multimembership" or the consideration that each identity is constructed based on the numerous community memberships that make up that identity. Etienne Wenger (1998) proposes that a fully formed identity is ultimately impossible, but it is through the work of reconciling memberships that important individual and community transformations can occur. Since Wenger also argues that reconciliation "is the most significant challenge" for those moving into new communities of practice (or, "engage in a process of collective learning in a shared domain of human endeavor" (4)), yet this challenge often remains tacit, this dissertation examines and makes explicit how this important work is done at two different research sites - a university writing center (the Michigan Tech Multiliteracies Center) and at a multinational corporation (Kimberly-Clark Corporation). Drawing extensively on qualitative ethnographic methods including interview transcriptions, observations, and case studies, as well as work from scholars in writing center studies (Grimm, Denney, Severino), literacy studies (New London Group, Street, Gee), composition (Horner and Trimbur, Canagarajah, Lu), rhetoric (Crowley), and identity studies (Anzaldua, Pratt), I argue that, based on evidence from the two sites, writing centers need to educate tutors to not only take identity into consideration, but to also make individuals' reconciliation work more visible, as it will continue once students and tutors leave the university. Further, as my research at the Michigan Tech Multiliteracies Center and Kimberly-Clark will show, communities can (and should) change their practices in ways that account for reconciliation work as identity, communication, and learning are inextricably bound up with one another.

Geology and Ore Deposits of the Golden Messenger MIne, Lewis and Clark County, Helena, Montana.

The Golden Messenger Mine which is approximately twenty-three miles northeast of Helena, Montana, near York, on Trout Creek, has long presented several problems of both theoretical and practical interest.

The Acropolitan - v. 1, no. 1

In this issue...Charlie McAuliffe, ore-diggers, Rhode's Scholarship, Glee Club, homecoming, George Fowler, Clark Park, Alumni banquet

Benefication of an Oxidized Lead Ore from the Franklin Mine Lewis and Clark County

This thesis is concerned with the beneficiation of an oxidized lead ore. Emphasis was placed upon concentration by flotation rather than by gravity methods, although some investigation was made with the Wilfley shaking table. The concentration of lead minerals received most consideration in the problem, but wherever possible attempts were made to increase the silver and gold concentration along with the lead.