The precision of human-generated hand-hygiene observations: a comparison of human observation with an automated monitoring system

We compared the observations of nearly 1,400 hand-hygiene-related events recorded by an automated system and by human observers. Observation details differed for 38% of these events. Two likely explanations for these inconsistencies were the distance between the observer and the event and the busyness of the clinic.

Healthcare personnel perceptions of hand hygiene monitoring technology

OBJECTIVE

To assess healthcare personnel (HCP) perceptions regarding implementation of sensor-based electronic systems for automated hand hygiene adherence monitoring.

DESIGN

Using a mixed-methods approach, structured focus groups were designed to elicit quantitative and qualitative responses on familiarity, comfort level, and perceived impact of sensor-based hand hygiene adherence monitoring.

SETTING

A university hospital, a Veterans Affairs hospital, and a community hospital in the Midwest.

PARTICIPANTS

Focus groups were homogenous by HCP type, with separate groups held for leadership, midlevel management, and frontline personnel at each hospital.

RESULTS

Overall, 89 HCP participated in 10 focus groups. Levels of familiarity and comfort with electronic oversight technology varied by HCP type; when compared with frontline HCP, those in leadership positions were significantly more familiar with ([Formula: see text]) and more comfortable with ([Formula: see text]) the technology. The most common concerns cited by participants across groups included lack of accuracy in the data produced, such as the inability of the technology to assess the situational context of hand hygiene opportunities, and the potential punitive use of data produced. Across groups, HCP had decreased tolerance for electronic collection of spatial-temporal data, describing such oversight as Big Brother.

CONCLUSIONS

While substantial concerns were expressed by all types of HCP, participants' recommendations for effective implementation of electronic oversight technologies for hand hygiene monitoring included addressing accuracy issues before implementation and transparent communication with frontline HCP about the intended use of the data.

Fingerprint lines may not directly affect SA-I mechanoreceptor response

Understanding how skin microstructure affects slowly adapting type I (SA-I) mechanoreceptors in encoding edge discontinuities is fundamental to understanding our sense of touch. Skin microstructure, in particular papillary ridges, has been thought to contribute to edge and gap sensation. Cauna's 1954 model of touch sensibility describes a functional relationship between papillary ridges and edge sensation. His lever arm model proposes that the papillary ridge (exterior fingerprint line) and underlying intermediate ridge operate as a single unit, with the intermediate ridge acting as a lever which magnifies indentation imposed at the papillary ridge. This paper contests the validity of the lever arm model. While correctly representing the anatomy, this mechanism inaccurately characterizes the function of the papillary ridges. Finite element analysis and assessment of the critical anatomy indicate that papillary ridges have little direct effect on how SA-I receptors respond to the indentation of static edges. Our analysis supports a revised (stiff shell-elastic bending support) interpretation where the epidermis is split into two major layers with a stiff, deformable shell over an elastic bending support. Recent physiological, electrophysiological, and psychophysical findings support our conclusion that the function of the intermediate ridge is distinct from the function of the papillary ridge.

Immunoglobulin and peripheral B-lymphocyte concentrations in Fell pony foal syndrome

REASONS FOR PERFORMING STUDY

Fell pony foals are affected by a congenital fatal disease that leads to profound anaemia and immunodeficiency. Previous studies comparing healthy and affected foals have shown normal T-cell populations, but a severe B-lymphopenia.

OBJECTIVES

To measure the levels of individual immunoglobulin subisotypes in normal and affected Fell ponies and correlate these levels with the number of peripheral B-lymphocytes.

METHODS

Serum levels of individual immunoglobulin subisotypes were measured by ELISA and correlated with the number of peripheral B-lymphocytes (measured by flow cytometry).

RESULTS

Affected foals had significantly reduced serum levels of IgM, IgGa, IgGb and IgG(T) that coincided with the normal reduction in maternally derived immunoglobulin in foals and, with the exception of IgGb, correlated strongly with the B-lymphopenia.

CONCLUSIONS

These data suggest that affected foals are unable to produce their own immunoglobulins. Therefore, once maternal immunity has waned, it may be the lack of specific foal-derived immunoglobulin that gives rise to the clinical signs of immunodeficiency.

POTENTIAL RELEVANCE

Measurement of IgM after age 4 weeks may provide a more accessible means of confirming the status of future affected Fell pony foals than the measurement of B-lymphocytes (a technique limited to a few specialist laboratories).

Augmented, pulsating tactile feedback facilitates simulator training of clinical breast examinations

Haptic training devices can facilitate tactile skill development by providing repeatable exposures to rare stimuli. Extant haptic training simulator research primarily emphasizes realistic stimuli representation; however, the experiments reported herein suggest that providing augmented feedback can improve training effectiveness, even when the feedback is not natural. A novel clinical breast examination training device uses inflated balloons embedded in silicone to simulate breast lumps. Oscillating the balloon water pressure makes the lumps pulsate. The pulsating lumps are easier to detect than the static lumps used in current simulators, and this manipulation seems to effectively introduce trainees to small, deep lumps that are initially difficult to perceive. A study of 48 medical students indicates that training with the dynamic breast model increased the number of lumps detected, F(1, 47) = 9.34, p = .004, decreased the number of false positives, F(1, 47) = 5.78, p = .020, and improved intersimulator skill transfer, F(1, 47) = 26.56, p < .001. The results suggest that at least in this case, augmented, tactile feedback increases training effectiveness, despite the fact that the feedback does not attempt to mimic any physical phenomenon present in the natural stimulus. Applications of this research include training techniques and tools for improved detection of palpable cancers.

Aid to the antemortem diagnosis of Fell pony foal syndrome by the analysis of B lymphocytes

Fell pony foals are affected by a congenital fatal immunodeficiency that commonly leads to anaemia and lymphopenia. Previous work has shown that the foals' circulating subpopulations of CD4 and CD8 T lymphocytes are unaffected. In this study it was shown that the mean population of B lymphocytes in 10 affected foals was less than 10 per cent of that in normal foals.

Effectiveness of a dynamic breast examination training model to improve clinical breast examination (CBE) skills

Despite the potential utility of clinical breast examination (CBE), doctors' palpation skills are often inadequate and difficult to train. CBE sensitivity ranges from 39-59%, in part because current training does not effectively teach tactile skills. To address CBE training limitations, we developed a breast examination training model with 15 dynamically controlled lumps, set to desired hardness within underlying rib and muscle structures, in a silicone breast. In an experiment of 48 medical students, training with the dynamic model increased lump detection by 1.35 lumps compared to 0.60 lumps for a traditional breast model (P=0.008), reduced false positives by -0.70 lumps compared to +0.42 lumps (P=0.0277), and demonstrated skill transfer with a 1.17 lump detection improvement on the traditional device compared to only a 0.17 lump detection improvement by traditional device trainees on the dynamic device (P<0.001). Findings demonstrate the advantage of the dynamic model over conventional models in training CBE tactile skills.

Clinical role of F-18 fluorodeoxyglucose positron emission tomography for detection and management of renal cell carcinoma

PURPOSE

We evaluate the accuracy of F-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET) for staging and management of renal cell carcinoma.

MATERIALS AND METHODS

FDG-PET was performed in 25 patients with known or suspected primary renal tumors and/or metastatic disease and compared with conventional imaging techniques, including computerized tomography (CT). Histopathological confirmation was obtained in 18 patients and confirmation of the disease was by followup in the remainder. The impact of FDG-PET on disease management was also assessed.

RESULTS

Of the 17 patients with known or suspected primary tumors FDG-PET was true positive in 15, true negative in 1 and false-negative in 1. Comparative CT was true positive in 16 patients and false-positive in 1. The accuracy of FDG-PET and CT was similar (94%). All patients would have undergone radical nephrectomy after conventional imaging findings but FDG-PET results altered treatment decisions for 6 (35%), of whom 3 underwent partial nephrectomy and 3 avoided surgery due to confirmation of benign pathology or detection of unsuspected metastatic disease. Of the 8 cases referred for evaluation of local recurrence and/or metastatic disease FDG-PET changed treatment decisions in 4 (50%), with disease up staged in 3 and recurrence excluded in 1. Compared with CT, FDG-PET was able to detect local recurrence and distant metastases more accurately and differentiated recurrence from radiation necrosis.

CONCLUSIONS

FDG-PET accurately detected local disease spread and metastatic disease in patients with renal cell carcinoma and altered treatment in 40%. FDG-PET may have a role in the diagnostic evaluation of patients with renal cell carcinoma preoperatively and staging of metastatic disease.

An analog of the human albumin N-terminus (Asp-Ala-His-Lys) prevents formation of copper-induced reactive oxygen species

Copper mobilization and redox activity form damaging reactive oxygen species (ROS) and are implicated in the pathogenesis of ischemia-reperfusion injury, chronic inflammation, Alzheimer's disease, aging, and cancer. Protein sequestration of Cu(II) ions has been shown to prevent ROS-generating reactions. The first four amino acids of the N-terminus of human albumin, Asp-Ala-His-Lys (DAHK), form a tight binding site for Cu(II) ions. We synthesized several analogs, including the enantiomer d-DAHK, to study their effects on copper-induced hydroxyl radical and superoxide formation in the presence of ascorbate. d-DAHK prevented thiobarbituric acid-reactive species (TBARS) formation within physiological and acidic pH ranges (7.5-6.5) and inhibited low-density lipoprotein lipid peroxidation. A d-DAHK/Cu complex exhibited superoxide dismutase-like activity by significantly inhibiting superoxide formation. These in vitro results suggest that d-DAHK may shift the Cu(II)-binding equilibrium from the exchangeable Cu(II) pool to the tightly-bound, nonexchangeable pool, prevent ROS formation, and potentially provide therapeutic benefit for ROS-related diseases.

Isoforms of Jun kinase are differentially expressed and activated in human monocyte/macrophage (THP-1) cells

Ten isoforms of c-jun N-terminal kinase (JNK) have been described that arise by differential mRNA splicing of three genes. In that the relative expression and function of these different JNK proteins in human monocytic cells is not known, we have examined the JNK isoforms in THP-1 monocyte/macrophage cells. Differentiation of THP-1 cells by exposure to 10(-8) M PMA for 42-48 h enhances cellular responses to LPS, including enhanced activation of total JNK activity and increased phosphorylation of p54 JNK as well as p46 JNK. Examination of JNK proteins on Western blots reveals a predominance of p46 JNK1 and p54 JNK2 proteins. Clearing of lysates by immunoprecipitation of JNK1(99% effective) removes 46% of the JNK enzymatic activity (p < 0.01), whereas clearing of JNK1 plus JNK2 (70% effective) depletes the sample of 72% of the JNK activity (p < 0.01). Further analysis, undertaken with real-time RT-PCR, revealed that 98% of the JNK messages code for three isoforms: JNK1beta1, JNK2alpha1, and JNK2alpha2. The p54 JNK that is phosphorylated in LPS-stimulated, PMA-differentiated THP-1 cells is most likely JNK2alpha2 because 97% of the p54 JNK-encoding messages code for JNK2alpha2. By analogous reasoning, the p46 JNKs that are not heavily phosphorylated, but account for approximately half of the N-terminal c-jun kinase enzymatic activity, are most likely either JNK1beta1 or JNK2alpha1 because they account for 98% of the messages that can code for 46kDa JNKS:

Asp-Ala-His-Lys (DAHK) inhibits copper-induced oxidative DNA double strand breaks and telomere shortening

Both DNA and the telomeric sequence are susceptible to copper-mediated reactive oxygen species (ROS) damage, particularly damage attributed to hydroxyl radicals. In this study, ROS-induced DNA double strand breaks and telomere shortening were produced by exposure to copper and ascorbic acid. Asp-Ala-His-Lys (DAHK), a specific copper chelating tetrapeptide d-analog of the N-terminus of human albumin, attenuated DNA strand breaks in a dose dependent manner. d-DAHK, at a ratio of 4:1 (d-DAHKCu), provided complete protection of isolated DNA from double strand breaks and, at a ratio of 2:1 (d-DAHKCu), completely protected DNA in Raji cells exposed to copper/ascorbate. Southern blots of DNA treated with copper/ascorbate showed severe depletion and shortening of telomeres and Raji cell treated samples showed some conservation of telomere sequences. d-DAHK provided complete telomere length protection at a ratio of 2:1 (d-DAHKCu). The human albumin N-terminus analog, d-DAHK, protects DNA and telomeres against copper-mediated ROS damage and may be a useful therapeutic adjunct in ROS disease processes.

NMR phase noise in bitter magnets

We have studied the temporal instability of a high field resistive Bitter magnet through nuclear magnetic resonance (NMR). This instability leads to transverse spin decoherence in repeated and accumulated NMR experiments as is normally performed during signal averaging. We demonstrate this effect via Hahn echo and Carr--Purcell--Meiboom--Gill (CPMG) transverse relaxation experiments in a 23-T resistive magnet. Quantitative analysis was found to be consistent with separate measurements of the magnetic field frequency fluctuation spectrum, as well as with independent NMR experiments performed in a magnetic field with a controlled instability. Finally, the CPMG sequence with short pulse delays is shown to be successful in recovering the intrinsic spin--spin relaxation even in the presence of magnetic field temporal instability.

Granulomatous glomerulonephritis in intravenous drug users: a report of three cases in oxycodone addicts

Various well-documented renal lesions are associated with intravenous drug use; however, intraglomerular mesangial granulomas have not been previously described. We report three patients who developed an unusual granulomatous glomerulonephritis and interstitial nephritis after intravenous injection of oxycodone, derived from suppositories. Granulomas were seen in an intraglomerular mesangial and also interstitial location. In both sites, the granulomas were associated with filamentous material, presumably derived from a component of the suppositories. This material was periodic acid-Schiff-positive, but negative with Congo red and silver stains. Ultrastructurally, the filamentous material was seen within the mesangial granulomas and also in a subendothelial location, suggesting derivation from the circulation with subsequent transport across the basement membrane and accumulation in the mesangium, where a granulomatous reaction was elicited. All patients developed a degree of renal failure; two of the patients require hemodialysis 20 and 30 months after presentation.

Dysembryoplastic neuroepithelial tumour: the Western Australian experience

Dysembryoplastic neuroepithelial tumour (DNET) is a rare tumour that is usually seen in the context of epilepsy surgery. The purpose of this study was to provide a profile of DNET in an unbiased population. The 2020 brain tumours diagnosed in Western Australia in the 10-year period 1982-1991 were reviewed; 5 cases of DNET were identified. All patients were neurologically intact and presented with complex partial seizures from a young age. Surgery was performed for tumour resection or biopsy in all cases; no patient underwent surgery specifically for epilepsy control. The lesions were intracortical, multinodular and were composed of astrocytes, oligodendrocytes and neurons. Three patients underwent total or subtotal resection and their seizures were either abolished or reduced in frequency. Two patients had biopsies only and were clinically unchanged. There has been no evidence of recurrence in up to 8 years' follow-up. The diagnosis of DNET is important because it is a surgically treatable benign tumour.

Stereotactic biopsy of 100 intracerebral lesions at Sir Charles Gairdner Hospital

The pathological findings in a retrospective review of 100 consecutive intracranial stereotactic biopsies are presented. Definite diagnosis could be established in the majority (89) of cases and included 85 neoplasms (69 primary cerebral tumors, 10 non-Hodgkin's lymphomas and 6 metastases) and 4 non-neoplastic processes. In the remaining 11 samples the findings were non-diagnostic; 2 consisted of normal glial tissue, while the remainder variously showed changes of necrosis, hematoma, histiocytic reaction or astrocytic proliferations of uncertain nature. Verification of the stereotactic diagnosis by examination of lesional tissue obtained at subsequent craniotomy or postmortem was possible in 7 of 10 cases. Two broad categories of diagnostic difficulty were identified in interpreting stereotactic biopsies: (1) accurate tumor typing and grading, and (2) the distinction between reactive and neoplastic astrocytic proliferations. Two essential components in the diagnostic process are: (1) careful correlation with the clinical and radiological findings; and (2) use of intraoperative smear and/or frozen section preparations to confirm specimen adequacy. By adhering to these principles accurate intraoperative diagnosis can usually be established, particularly for high grade astrocytoma, lymphoma and metastasis. Tumor typing is aided by the use of immunohistochemistry and ultrastructural examination and the examination of serial sections is of value in grading.

Retaining Army nurses: a longitudinal model

A longitudinal sample of active duty Army nurses working in a broad range of nursing specialties and settings was analyzed for retention behavior. A turnover model of actual retention behavior, estimated using logistic regression, included external market, personal/demographic, and work-related variables as explanatory factors. Satisfaction with work and military life, satisfaction with location/assignment stability, race--ethnic group, and family status had significant effects on the retention of Army junior nurse-officers.

Vincristine with high-dose etoposide in advanced breast cancer: a phase II trial of the Piedmont Oncology Association

Vincristine (VCR) and etoposide (VP-16) have been shown to be synergistic in a murine model, and this combination was studied in a phase II trial. Eligibility required measurable disease, a performance status of 0-2, a life expectancy of > or = 2 months, an interval of at least 3 weeks since the receipt of previous radiation therapy or chemotherapy and recovery from related toxicity, no prior treatment with VCR or VP-16, and no more than two prior chemotherapy regimens (only one for treatment of metastatic disease). Treatment consisted of 0.5 mg i.v. (bolus) VCR followed by 200 mg/m2 VP-16 given over 2 h. Both drugs were given daily for 3 consecutive days every 3 weeks (total dose: VCR, 1.5 mg; VP-16, 600 mg/m2). A total of 18 patients with metastatic breast cancer were accured; 14 had adjuvant chemotherapy and 8 had chemotherapy for advanced disease. As judged by International Union Against Cancer (UICC) criteria, one complete response (CR) and three partial responses (PR) were obtained, for a CR + PR rate of 22% (95% confidence interval, 6%-48%). All responders had soft-tissue involvement only. Six patients had stable disease and 8 showed progression. The median time to treatment failure was 3.5 months, and the median survival from study entry was 8.3 months. The major toxicity was myelosuppression, with 9 patients (50%) experiencing a total WBC of < 1,000/mm3. Grade 2-3 neurologic toxicity was noted in 6 patients (33%) and grade 3 nausea and vomiting was noted in 5 (28%). The combination of VCR and VP-16 is active in advanced breast cancer but is not convincingly superior to either of these agents used alone.

Comparison of two management systems of dairy farmlets based on conservation of either hay or silage

Two management systems for dairy farms, early (silage farmlet) and late (hay farmlet) conservation, were compared for milk production in 4 consecutive years, at 2 cowsha. Half of the total silage farmlet area was made to wilted silage in each year. The remaining area was conserved as direct-cut silage in the first year and hay in the fourth year. About 40-50% of the hay farmlet area was made to hay. Over the 4 years, the silage farmlet produced an average of 8.2% more milk and 11.9% more (P<0.01) milk fat per year than the hay farmlet. The improvement in milk and milk fat production averaged 2.7 and 5% (P<0.01) in the spring and 27.4 and 30% (P<0.01) in the period from commencement of supplementary feeding in the summer. On average, the silage farmlet conserved a greater area, but because of high storage losses and greater consumption, it required more brought-in feed than the hay farmlet.

Pancreatitis in northern Newfoundland and Labrador: a 20-year review of the Grenfell Regional Health Services experience

A retrospective review of the Grenfell Regional Health Services experience with pancreatitis over a 20-year period (1968-1987) has been presented. The small number of cases in this series precludes meaningful statistical analysis, however, in general, one can state that native peoples are represented in this study in roughly the same proportion as they are represented in the population served. We have demonstrated that pancreatitis in its chronic form does occur in the Inuit of Northern Labrador. Given the prominent role that alcohol abuse plays in the social and behavioral ills of Labrador's native peoples as reflected in the high incidence of family violence, accidental deaths, and suicides, one might anticipate a disproportionately high incidence of pancreatitis and its chronic sequelae among the Inuit. The answer to this seeming paradox may be found through future study of the nature of the alcohol consumed, its pattern of consumption or of genetically-determined differences in the metabolism of alcohol and its toxic effects within the body, of differences in the composition of pancreatic secretions, or of environmental and dietary factors.