An interactive feedback system for increasing hand antisepsis adherence in stationary intensive care.

BACKGROUND: Pathogens causing infections are in many cases transmitted via the hands of personnel. Thus, hand antisepsis has strong epidemiological evidence of infection prevention. Depending on various factors, hand antisepsis adherence ranges between 9.1% and 85.2%. AIM: To evaluate a new transponder system that reminded medical staff to use an alcohol-based hand rub based on indication by giving real-time feedback, to detect hand antisepsis adherence. METHODS: The monitoring system consisted of three components: a portable transponder detecting alcohol-based hand rub and able to give feedback; a beacon recognizing entries to and exits from the patient's surroundings; and a sensor placed at the hand-rub dispensers to count the number of hand rubs. With these components, the system provided feedback when hand antisepsis was not conducted although it was necessary according to moments 1, 4, and 5 of hand antisepsis. Adherence was measured in two use-cases with five phases, starting with the baseline measurement followed by intervention periods and phases without intervention to test the sustainability of the feedback. FINDINGS: Using the monitoring system, hand antisepsis adherence was increased by up to 104.5% in comparison to the baseline measurement. When the intervention ceased, however, hand antisepsis adherence decreased to less than or equal to the baseline measurement. CONCLUSION: A short-term intervention alone is not sufficient to lead to a long-term change in hand antisepsis adherence. Rather, permanent feedback and/or the integration in a multi-modal intervention strategy are necessary.

Recovery after long-term summer drought: Hydraulic measurements reveal legacy effects in trunks of Picea abies but not in Fagus sylvatica.

Climate change is expected to increase the frequency and intensity of summer droughts. Sufficient drought resistance, the ability to acclimate to and/or recover after drought, is thus crucial for forest tree species. However, studies on the hydraulics of mature trees during and after drought in natura are scarce. In this study, we analysed trunk water content (electrical resistivity: ER) and further hydraulic (water potential, sap flow density, specific hydraulic conductivity, vulnerability to embolism) as well as wood anatomical traits (tree ring width, conduit diameter, conduit wall reinforcement) of drought-stressed (artificially induced summer drought via throughfall-exclusion) and unstressed Picea abies and Fagus sylvatica trees. In P. abies, ER indicated a strong reduction in trunk water content after 5 years of summer drought, corresponding to significantly lower pre-dawn leaf water potential and xylem sap flow density. Vulnerability to embolism tended to be higher in drought-stressed trees. In F. sylvatica, only small differences between drought-stressed and control trees were observed. Re-watering led to a rapid increase in water potentials and xylem sap flow of both drought-stressed trees, and to increased growth rates in the next growing season. ER analyses revealed lower trunk water content in P. abies trees growing on throughfall-exclusion plots even 1 year after re-watering, indicating a limited capacity to restore internal water reserves. Results demonstrated that P. abies is more susceptible to recurrent summer drought than F. sylvatica, and can exhibit long-lasting and pronounced legacy effects in trunk water reserves.

The influence of additions of Al and Si on the lattice stability of fcc and hcp Fe-Mn random alloys.

We have studied the influence of additions of Al and Si on the lattice stability of face-centred-cubic (fcc) versus hexagonal-closed-packed (hcp) Fe-Mn random alloys, considering the influence of magnetism below and above the fcc Néel temperature. Employing two different ab initio approaches with respect to basis sets and treatment of magnetic and chemical disorder, we are able to quantify the predictive power of the ab initio methods. We find that the addition of Al strongly stabilizes the fcc lattice independent of the regarded magnetic states. For Si a much stronger dependence on magnetism is observed. Compared to Al, almost no volume change is observed as Si is added to Fe-Mn, indicating that the electronic contributions are responsible for stabilization/destabilization of the fcc phase.

Ab initio lattice stability of fcc and hcp Fe-Mn random alloys.

We have studied the lattice stability of face centred cubic (fcc) versus hexagonal close packed (hcp) Fe-Mn random alloys using ab initio calculations. In the calculations we considered the antiferromagnetic order of local moments, which for fcc alloys models the magnetic configuration of this phase at room temperature (below its Néel temperature) as well as their complete disorder, corresponding to paramagnetic fcc and hcp alloys. For both cases, the results are consistent with our thermodynamic calculations, obtained within the Calphad approach. For the room temperature magnetic configuration, the cross-over of the total energies of the hcp phase and the fcc phase of Fe-Mn alloys is at the expected Mn content, whereas for the magnetic configuration above the fcc Néel temperature, the hcp lattice is more stable within the whole composition range studied. The increase of the total energy difference between hcp and antiferromagnetic fcc due to additions of Mn as well as the stabilizing effect of antiferromagnetic ordering on the fcc phase are well displayed. These results are of relevance for understanding the deformation mechanisms of these random alloys.

Neurotrophin-3, but not nerve growth factor, promotes survival of human intestinal mast cells.

Neurotrophins are potent regulators of neuronal cell survival and function. Nerve growth factor (NGF) was shown to reduce apoptosis in cord blood-derived mast cells. Here, we examined the effect of the neurotrophins NGF and neurotrophin (NT)-3 on survival and mediator release of human intestinal mast cells. Mast cells isolated from normal intestinal tissue were cultured in the presence of NGF, NT-3, or stem cell factor (SCF) alone or in the presence of SCF together with each neurotrophin. NGF or NT-3 alone did not promote mast cell survival. In contrast, mast cell recovery was increased twofold when mast cells were cultured with NT-3 in addition to SCF for 14 days compared with control. Mast cell recovery was further increased following a combined addition of NT-3, SCF and IL-4. NT-3 mediated mast cell growth was dependent on the primary receptor for NT-3 TrkC. NGF in combination with SCF or with SCF and IL-4 showed no effect on mast cell survival. Histamine release and histamine content per mast cell remained unchanged, whereas leukotriene C4 release decreased if mast cells were cultured with NGF or NT-3 in addition to SCF. In summary, NT-3 affects mature human mast cells by promoting mast cell survival, whereas NGF does not.

Growth, phenotype, and function of human intestinal mast cells are tightly regulated by transforming growth factor beta1.

BACKGROUND AND AIMS: Transforming growth factor beta1 (TGF-beta1) is expressed in the healthy human intestine and controls mucosal immune responses and inflammation by regulating the function of lymphocytes, macrophages, dendritic cells, and eosinophils. Here, we asked whether human intestinal mast cells (MC) might also be subject to immunoregulation by TGF-beta1. METHODS: MC were isolated from the intestinal mucosa, purified, and cultured in vitro in the presence of stem cell factor (SCF) with or without TGF-beta1. Growth characteristics, phenotype, and immunological mediator release of MC were analysed by reverse transcription-polymerase chain reaction, flow cytometry, immunocytochemistry, western blot, and different immunoassays, respectively. RESULTS: TGF-beta1 dose dependently (ED50 approximately = 0.1 ng/ml) inhibited SCF dependent growth of human intestinal MC by both enhancing apoptosis and decreasing proliferation. In parallel, TGF-beta1 increased the percentage of connective tissue-type MC expressing tryptase and chymase while downregulating expression of the receptors for IgE and SCF. Furthermore, TGF-beta1 dramatically changed the profile of mediators released by MC following IgE receptor crosslinking. Release of histamine, cysteinyl-leukotrienes, and tumour necrosis factor alpha was strongly reduced whereas prostaglandin D2 generation and cyclooxygenase 1 and 2 expression were upregulated by TGF-beta1. CONCLUSIONS: Our data indicate that TGF-beta1 acts as a novel potent inhibitor and modulator of human intestinal MC effector functions. The change in MC mediator release profile and protease expression induced by TGF-beta1 might be of relevance for the control of MC associated disorders of the intestine such as allergic reactions, Crohn's disease, irritable bowel syndrome, and parasitic infection.

A campus-community coalition to control alcohol-related problems off campus: an environmental management case study.

The authors report on the effects of a university and community coalition in preventing problems related to college students' off-campus drinking. The Albany, New York, Committee on University and Community Relations used strategies based on an environmental-management approach that focuses on changing the environment in which individuals make decisions about alcohol consumption and related behaviors. Committee initiatives included improving enforcement of local laws and ordinances, creating a safety-awareness campaign for off-campus students, and developing a comprehensive advertising and beverage-service agreement with local tavern owners. The initiatives were associated with a decline in the number of alcohol-related problems in the community, as indicated by decreases in the number of off-campus noise ordinance reports filed by police and the number of calls to a university-maintained hotline for reporting off-campus problems. An environmental management approach, the authors suggest, has promise as an effective means of preventing alcohol-related problems among college students.

Effects of the forearm support band on wrist extensor muscle fatigue.

STUDY DESIGN: A crossover experimental design with repeated measures. OBJECTIVE: To determine whether the forearm support band alters wrist extensor muscle fatigue. BACKGROUND: Fatigue of the wrist extensor muscles is thought to be a contributing factor in the development of lateral epicondylitis. The forearm support band is purported to reduce or prevent symptoms of lateral epicondylitis but the mechanism of action is unknown. METHODS AND MEASURES: Fifty unimpaired subjects (36 men, 14 women; mean age = 29 +/- 6 years) were tested with and without a forearm support band before and after a fatiguing bout of exercise. Peak wrist extension isometric force, peak isometric grip force, and median power spectral frequency for wrist extensor electromyographic activity were measured before and after exercise and with and without the forearm support band. A 2 x 2 repeated measures multivariate analysis of variance was used to analyze the data, followed by univariate analysis of variance and Tukey's multiple comparison tests. RESULTS: Peak wrist extension isometric force, peak grip isometric force, and median power spectral frequency were all reduced after exercise. However, there was a significant reduction in peak grip isometric force and peak wrist extension isometric force values for the with-forearm support band condition (grip force 28%, wrist extension force 26%) compared to the without-forearm support band condition (grip force 18%, wrist extension force 15%). CONCLUSIONS: Wearing the forearm support band increased the rate of fatigue in unimpaired individuals. Our findings do not support the premise that wearing the forearm support band reduces muscle fatigue in the wrist extensors.

[Extracorporeal shockwave therapy in tendionosis calcarea of the rotator cuff: comparison of different treatment protocols]. / Extrakorporale Stosswellentherapie bei der Tendionosis calcarea der Rotatorenmanschette: Vergleich verschiedener Behandlungsprotokolle.

AIM OF THE STUDY: Extracorporeal shock wave therapy (ESWT) is a new therapeutic procedure for chronically painful calcifying tendinitis of the rotator cuff. The therapy may vary with the number of applied impulses or with impulse energy. Shock waves with an energy of 0.04 to 0.12 mJ/mm2 define low-dose ESWT, in contrast to high-dose ESWT (> 0.12 mJ/mm2). The aim of the study was to verify the hypothesis that either high-dose or low-dose ESWT could be effective if the total amount of applied energy was similar. METHOD: Fifty patients were assigned at random to 2 groups. The treatment consisted of 3 x 5000 low-dose impulses without anesthesia (group 1) and 1 x 5000 high-dose impulses with intravenous analgesia (group 2). The patients were examined at 6 weeks, 3 and 6 months after treatment. X-rays were performed at each visit. RESULTS: The Constant Score improved from 64.5 to 77.5 (group 1) and from 67.2 to 79.4 (group 2) before and 6 months after treatment (p < 0.05). The values on the visual analog scale which ranges from 0 (no pain) to 100 (maximal pain) improved from 76.8 to 48.8 (group 1) and from 75.4 to 45.6 (group 2) before and 6 months after treatment respectively. The final results for both Constant Score and visual analog scale were obtained after 3 months. X-rays showed a complete or subtotal calcific resorption in 8 (group 1, 32%) and 12 (group 2, 48%) patients. CONCLUSION: Extracorporeal shock wave therapy may be an alternative treatment of calcifying tendinitis of the shoulder. Both treatment protocols gave equivalent results.

[Chronic persistent cough in general practice: diagnosis and therapy in 329 patients over the course of 2 years]. / Chronisch persistierender Husten (CPH) in der Praxis: Diagnostik und Therapie bei 329 Patienten in 2 Jahren.

Chronic Cough: Chronic persistent cough (CPC) lasting from several months to years - without radiographic or spirometric evidence of its cause - was a surprisingly frequent reason (5,7% of all new referrals) to consult our practice. Sophisticated diagnostic evaluation and therapeutic regimen are necessary. We performed a prospective study on 329 consecutive patients (106 male, 223 female) over a two-year period. 65% of the patients had cough as a consequence of bronchial hyperresponsiveness; 27% due to upper airways disease, i.e. often very common rhinitis or pharyngitis; 14% chronic bronchitis; 5% gastrooesophageal reflux (GER); 3% drug induced cough; 4% other causes. 10% of the patients discontinued the diagnostic evaluation prematurely. In 14% the cause for CPC remained unclear and no relief could be achieved. Furthermore, there is a need for consecutive studies to address the following questions: 1. The cause of the striking difference in gender (male : female = 1 : 2) remains unclear. 2. Wether a cough recorder - as occasionally reported in the literature - is needed for an objective evaluation of cough [9]. 3. A standardised methodology of 24 h pH monitoring for the diagnosis of CPC as a consequence of GER has yet to be established.

[Extracorporeal lithotripsy of gallbladder calculi with piezoelectrically generated shock waves: initial experiences]. / Die extrakorporale Lithotripsie von Gallenblasensteinen mit piezoelektrisch erzeugten Stosswellen: erste Erfahrungen.

A piezoelectric lithotripter ("Piezolith 2300") was used in 24 patients for extracorporeal fragmentation of radiolucent gallbladder stones. In 19 patients with one stone and 4 patients with two stones (diameter: 0.8-3.1 cm) fragmentation to a maximal fragment size of 7 mm was achieved. One to three treatment sessions were necessary (mean 1.5). During adjuvant oral litholytic therapy with chenodeoxycholic acid and ursodeoxycholic acid (500 mg each daily up to 80 kg bodyweight and 750 mg in patients with more than 80 kg bodyweight) 4 patients came to be completely free of stones within a mean follow-up time of 15 weeks. Treatment was well tolerated by all patients, no analgesia or sedation was needed. Side effects were cutaneous petechiae in two patients, microscopic haematuria in two others and leucocyturia in another. We conclude that lithotripsy of gallbladder stones can be performed safely and effectively not only by the established underwater spark discharge type of lithotripter but also by the piezoelectric system.

[Disintegration of kidney calculi with a piezoelectric instrument system. Initial clinical experiences]. / Die Zertrümmerung von Nierensteinen mit einem piezoelektrischen Gerätesystem. Erste klinische Erfahrungen.

Since December 1985 extracorporeal piezoelectric renal lithotripsy has been tested in humans. Up to now 50 patients with renal calculi have been treated. The lithotriptor consists of a special mobile table with an opening in the surface to apply shock waves. Urinary calculi are located by integrated ultrasound location systems. As the piezoelectrically generated high-energy sound pulse does not cause pain, treatment is possible without anesthesia. Permanent ultrasonic control of the stones in the focus during lithotripsy allows effective application of shock waves. With this piezoelectric system the electrocardiogram does not have to be triggered. So far the results have been encouraging and following these tests clinical application is expected to be successful.

[Disintegration of kidney calculi by piezoelectrically generated high-energy sound waves. Physical principles and experimental studies]. / Die Zertrümmerung von Nierensteinen durch piezoelektrisch erzeugte Hochenergie-Schallpulse. Physikalische Grundlagen und experimentelle Untersuchungen.

The recently developed equipment for extracorporeal piezoelectric lithotripsy (EPL) represents an improvement concerning the shock-wave-induced disintegration of urinary calculi. While the usual spark gap transmitter needs a focusing reflector, the piezoelectric lithotriptor is based on a self-focusing spherical bowl transmitter. The stone is detected exclusively by ultrasound. For this purpose, an integrated sector scanner is used as well as the high-energy sound transmitter itself. With the piezoelectrically generated high-energy sound pulses we have succeeded in completely disintegrating implanted stones in the renal pelvis of dogs without injuring the morphology or function of the exposed kidneys.

A comparative assessment of carbuterol, fenoterol and hexoprenaline in allergic asthma.

Carbuterol tablets (2,0 mg) were compared with the tablets of fenoterol (2,5 mg) and hexoprenaline (1 mg). The three drugs were shown to be equally effective for a period of 4 hours, but carbuterol and fenoterol exerted a statistically significant bronchodilating action for 7 and 8 hours respectively, while the action of hexoprenaline lasted for 4 hours in the majority of patients. The aerosols of carbuterol (200 mg) and fenoterol (400 mg) appeared to be similar in inhibiting exercise-induced asthma, whereas hexoprenaline (200 mg) did not appear to be as effective.