Increasing pneumococcal vaccination rates among residents of long-term--care facilities: provider-based improvement strategies implemented by peer-review organizations in four western states.

OBJECTIVE: To evaluate collaborative efforts and intervention strategies by peer-review organizations (PROs) and long-term-care facilities (LTCFs) for improving pneumococcal vaccination rates among residents of LTCFs. DESIGN: Prospective, before-after quality improvement project. SETTING: 133 LTCFs in Alaska, Idaho, Montana, and Wyoming. PATIENTS: All residents of participating LTCFs. METHODS: Baseline pneumococcal vaccination rates were determined by medical-record review, self-reporting by patient or family members, and review of Medicare claims information. Remeasurement of vaccination rates was accomplished from documentation of vaccination of eligible residents by each LTCF. RESULTS: 133 LTCFs with 7,623 residents from Alaska, Idaho, Montana, and Wyoming participated in this quality-improvement project. This accounted for 41% (133/321) of the potential nursing homes and resident population in the participating states. Baseline overall vaccination rates were 40% (3,050/7,589). The overall vaccination rate improved to 75% (5,720/7,623, P<.001). The number of facilities meeting the Healthy People 2000 vaccination goal of 80% improved from 18% (24/133) to 62% (83/133, P<.001). Initial use of chart stickers and implementation of standing orders led to similar increases in vaccination rates, but the standing-order strategy required commitment of fewer PRO resources at a statewide level. Remeasurement of vaccination rates in a subset of participating Idaho LTCFs 1 year after initial vaccination efforts demonstrated a sustained vaccination rate of 70% in facilities enforcing a standing-order policy. CONCLUSIONS: Simple and straightforward vaccination strategies implemented in LTCFs over a short period of time can have a significant impact on vaccination rates. Collaborative efforts between state PROs and LTCFs enhance implementation of these strategies and can result in the achievement of national vaccination objectives. Standing orders appear to be one intervention effective in sustaining successful vaccination efforts. Regardless of the specific interventions employed, PROs played a significant role in facilitating vaccination program development and intervention implementation.

A xylosyltransferase involved in the synthesis of a protein-associated xyloglucan in suspension-cultured dwarf-French-bean (Phaseolus vulgaris) cells and its interaction with a glucosyltransferase.

A particulate enzyme preparation made from suspension-cultured dwarf-French-bean (Phaseolus vulgaris) cv. Canadian Wonder cells was shown to incorporate xylose from UDP-D-[14C]xylose into polysaccharide. The reaction was dependent upon the presence of UDP-D-glucose and was stimulated, and apparently protected, by GDP-D-glucose and GDP-D-mannose, though neither was able to replace UDP-D-glucose as a glycosyl donor. The product of the reaction was identified as xyloglucan by analysis of products of enzyme breakdown and acid hydrolysis. Mr determination after proteinase K digestion indicated that the nascent xyloglucan is closely associated with protein. Preincubation of the enzyme with UDP-D-glucose stimulated incorporation from UDP-D-[14C]xylose, suggesting an 'imprecise' mechanism of biosynthesis, as defined by Waldron & Brett [(1985) in Biochemistry of Plant Cell Walls (Brett, C. T. & Hillman, J. R., eds.) (SEB Semin. Ser. 28), pp. 79-97, Cambridge University Press, Cambridge].

ABSCISIC ACID AND DORMANCY IN ROOT-NODULATED ALNUS GLUTINOSA (L.) GAERTN.

Treatment of three-month or six-month-old water culture plants of Alnus glutinosa with 0.1 mol m-3 (±) abscisic acid (ABA) induced formation of resting buds after 30 to 60 d. Leaf dry weight per plant decreased by 40 to 45 % during this period but root and nodule dry weights were unchanged relative to control plants. [2-14 C] ABA was taken up by the root system within 5 d and after 30 or 60 d the ABA content of plants fed 01 mol m-3 ABA was 60 and 119 times that of control plants. In control plants, the levels of 'free'cis(Z) ABA were similar to or exceeded 'free'trans(E) ABA in all plant parts while, in general, the converse was true for these isomers in 'bound' form. In ABA-treated plants, all isomeric forms of ABA were present at much higher amounts than in the controls but, whereas in leaves and shoot apices the amount of cis ABA in both 'free' and 'bound' forms was much greater than the trans isomer, in roots and nodules trans ABA was the dominant isomer in both 'bound' and 'free' forms. Most biologically active 'free'cis ABA thus accumulated in the leaves and shoot apex, where effects of ABA treatment on growth were most evident, whereas in roots and nodules where biologically inactive 'free' and 'bound'trans ABA were dominant, growth was relatively unaffected. Amounts of 'free' ABA in nodules were several times those recorded previously in nodules of dormant plants, in keeping with earlier suggestions that ABA is unlikely to have a precise regulatory role in growth and dormancy of nodules.

Metabolism of [(14)C]indole-3-acetic acid by the cortical and stelar tissues of Zea mays L. roots.

Reverse-phase high-performance liquid chromatography was used to analyse (14)C-labelled metabolites of indole-3-acetic acid (IAA) formed in the cortical and stelar tissues of Zea mays roots. After a 2-h incubation in [(14)C]IAA, stelar segments had metabolised between 1-6% of the methanol-extractable radioactivity compared with 91-92% by the cortical segments. The pattern of metabolites produced by cortical segments was similar to that produced by intact segments bathed in aqueous solutions of [(14)C]IAA. In contrast, when IAA was supplied in agar blocks to stelar tissue protruding from the basal ends of segments, negligible metabolism was evident. On the basis of its retention characteristics both before and after methylation, the major metabolite of [(14)C]IAA in Zea mays root segments was tentatively identified by high-performance liquid chromatography as oxindole-3-acetic acid.

Sensitivity of Commelina stomata to abscisic acid.

Stomata of Commelina leaves pre-opened by incubation in moist air were found to close within 30 min when supplied with abscisic acid (ABA) via the transpiration stream. Radioactive ABA had similar effects, but allowed the distribution of the compound within the leaf to be measured and correlated with stomatal movements to give estimates of the sensitivity of Commelina stomata. On a whole-leaf basis, less than 163 fmol ABA per mm(2) leaf area were present at the time of complete stomatal closure. This was close to other published estimates. By taking epidermal (14)C measurements, however, it was possible to increase the accuracy of the estimate on the assumption that only ABA present in the epidermis was physiologically active. Thus, less than 235 amol ABA for stomatal complex were present at complete closure, and statistically significant narrowing of the stomatal aperture had occurred when between 12.6 and 45.4 amol per complex were present. The distribution of ABA within the epidermal tissue after transpiration-stream application was studied using microautoradiography, and the compound appeared to have accumulated within the stomatal complex.

Uptake and distribution of abscisic acid in Commelina leaf epidermis.

Closure of stomata by abscisic acid (ABA) was studied by floating leaf epidermal strips of Commelina communis L. in PIPES buffer (pH 6.8) containing a range of KCl concentrations. Control apertures were greatest at high concentrations of the salt, and the effects of ABA, in terms of closure, were most pronounced below 100 mol m(-3) KCl. Stomata opened on strips floated on buffer plus 50 mol m(-3) KCl and closed within 10 min when transferred to the same medium plus 0.1 mol m(-3) ABA. [2-(14)C]ABA was used to study uptake and distribution of the hormone by the epidermal strips. It was calculated that no more than 6 fmol ABA were present per stomatal complex at the time of closure, although uptake continued thereafter. Microautoradiography indicated that radioactivity from [2-(14)C]ABA accumulated in the stomatal complex at or near the guard cells within 20 min. TLC was used to examine the state of the label after 1 h incubation. Efflux of label from preincubated tissue appeared to occur in three phases (t1/2=7.2 s, 4.0 min, 35.2 min). Efflux was correlated with stomatal re-opening. The results confirm that ABA can accumulate in the epidermis of C. communis.

Apical dominance and the levels of indole acetic acid in Phaseolus lateral buds.

Combined gas chromatography-mass spectrometry procedures have been used to establish that the indole acetic acid levels of lateral buds from Phaseolus seedlings rise following removal of the shoot apex.

The involvement of indole acetic acid in the thermodormancy of lettuce fruits, Lactuca sativa cv. Grand Rapids.

At 20° C and at 30° C in darkness, concentrations of indole acetic acid (IAA) greater than 10(-7) M inhibited the germination of Grand Rapids lettuce at 24 h and 48 h after the beginning of imbibition. There was no marked, readily defined period of inhibition during germination that could be associated solely with an effect of IAA on suppressing radicle extension. Gibberellin A4+7, benzyladenine and red light were capable of reversing the effects of IAA. There was no consistent pattern of change in the low endogenous levels (less than 11 µg kg(-1)) of extractable IAA during the first 30 h after imbibition.

Correlative inhibition of lateral bud growth in Phaseolus vulgaris L. timing of bud growth following decapitation.

On intact, 3-week-old plants of Phaseolus the larger bud in the axils of the primary leaves shows slow, continuous elongation growth. Release from correlative inhibition can be detected within 30 min following decapitation. When 0.1% indoleacetic acid in lanolin is applied to the decapitated stem stump, the lateral bud shows slow growth during the first 7 h, then stops completely for a further 15 h but after 2 days a further gradual increase in length is observed.The movement of (14)C-labelled assimilates from the subtending primary leaf into the lateral bud increases following removal of the shoot apex. When indole acetic acid is applied to decapitated plants the ability of the buds to import (14)C increases for 5-7 h and then declines to a negligible amount. Little or no radioactivity from tritiated indoleacetic acid is transported into the lateral buds of decapitated plants during the first 48 h following removal of the apex and it appears that rapid metabolism of the compound occurs in the stem tissues.

Uptake of 2-[(14)C]abscisic acid by senescing leaf tissue of radish, Raphanus sativus L.

The uptake of [(14)C]abscisic acid by radish leaf discs rises one to two days after excision and then declines to six days. This pattern of uptake is not identical to the uptake of [(14)C]sucrose. The uptake of both [(14)C]abscisic acid and [(14)C]sucrose is substantially reduced by anaerobic conditions.

Studies on the role of abscisic acid in the initiation of bud dormancy in Alnus glutinosa and Betula pubescens.

The effects of leaf-applied (+-)-abscisic acid on the growth and dormancy of Betula pubescens Ehrh. and Alnus glutinosa Gaertn. growing under long days provide no evidence that leaf-applied abscisic acid induces or promotes the formation of resting buds in these species. Radiotracer studies show that a small percentage of the radioactivity applied as [2-(14)C]abscisic acid to the leaves accumulates in the apical region of the shoot. Of the radioactivity that was recovered from this region after 8 days, less than 10% was chromatographically similar to [2-(14)C]abscisic acid. The significance of these results with respect to the role of abscisic acid in regulating the induction of bud dormancy is discussed.

Abscisic acid in leaves of Hedera helix L.

Abscisic acid was detected by gas-liquid chromatography of the methyl esters in the acid fraction of extracts from leaves of juvenile and adult Hedera helix L. Combined gas chromatography-mass spectrometry data were obtained for the extract of adult tissues and thin-layer chromatography, gas-liquid chromatography and gas chromatography-mass spectrometry data for that of juvenile tissues. An estimation of the amounts of abscisic acid present in extracts from both growth phases was carried out using a single ion monitoring technique.

Studies on the action of abscisic acid on IAA-induced rapid growth of Avena coleoptile segments.

A linear displacement transducer has been used to monitor the growth of a column of Avena coleoptile segments in flowing solution. IAA at 10(-5)M in phosphate buffer of pH7 promotes growth after a latent period of 10.9 min, the initial maximum growth rate occurring after 25 min. Simultaneous treatment with 10(-5) M ABA does not affect either the latent period or the initial maximum growth rate in response to the IAA treatment, but subsequently gives rise to an inhibition of growth detectable after 30 min. In contrast, pretreatment with ABA for 100 min increases the duration of the latent period and reduces the initial maximum growth rate. Removal of the ABA rapidly relieves the inhibition of IAA-induced growth but a growth rate comparable to that of material treated only with IAA is never attained. Studies using 2-[(14)C]ABA and 1-[(14)C]IAA suggest that the latent period before ABA inhibition of growth is detectable is not due to a lag in ABA uptake, and that ABA is not acting by reducing IAA uptake.