Electronic hand hygiene monitoring: accuracy, impact on the Hawthorne effect and efficiency.

OBJECTIVES: To evaluate a type five electronic monitoring system (EMS) for hand hygiene (HH) adherence with respect to accuracy and ability to avoid the Hawthorne effect. DESIGN: HH events were observed manually and electronically. The agreement between the two observation methods was evaluated. Continuous electronic measurement was made throughout the study. SETTING: An acute 31-bed medical ward in a National Health Service trust in London, United Kingdom. PARTICIPANTS: Staff working or attached to the ward. INTERVENTION: A newly developed type five EMS that can measure disinfectant dispenser usage as well as continuous movements of health workers throughout the ward with arm-length precision and analyse HH adherence was installed at the ward. RESULTS: A total of 294 HH events were observed in five sessions by an observer previously unknown to the ward. There was concordance between HH adherence assessed by manual observer and the EMS on 84% (79.1%-89.9%) of the occasions. During the five observation sessions, the observed HH adherence increased from 24% to 76% while the EMS measurements immediately before the arrival of the observer remained constant for all sessions. CONCLUSION: The 84% agreement between the EMS and the manual observation suggest a high level of precision for the evaluated system. The Hawthorne effect (higher rate of HH performance) was clearly seen in the increase by a factor of three in the manually observed adherence from session to session as the health workers became more aware of them being observed. The EMS was able to avoid the Hawthorne effect when the observer was not present.

Cortinarius subgenus Callistei in North America and Europe-type studies, diversity, and distribution of species.

Five species of Cortinarius subgenus Callistei, are recognized in Europe and North America. Cortinarius callisteus, C. infucatus, and C. neocallisteus sp. nov. have a broad distribution, extending from western North America to Europe. Cortinarius tofaceus is known from eastern North America and Europe, while C. callistei sp. is known only from one locality in Sweden. All five species are primarily associated with coniferous trees. Previously the species were included either in subgenus Leprocybe or subgenus Cortinarius, but recently they have been separated into subgenus Callistei based on molecular data. Type specimens of the names associated with this subgenus were studied and a neotype proposed for C. tofaceus and an epitype for C. infucatus Barcodes for the species are deposited in RefSeq and UNITE.

The species of Cortinarius, section Bovini, associated with conifers in northern Europe.

Cortinarius bovinus and morphologically similar conifer-associated species were studied using material mainly from northern Europe. To stabilize the nomenclature, relevant types were examined. Phylogenetic relationships and species limits were investigated with rDNA ITS and nuclear rpb2 sequences as well as morphological data. We recognize seven species: C. bovinus (neotypified) and six new species, C. anisochrous, C. bovinaster, C. bovinatus, C. fuscobovinus, C. fuscobovinaster and C. oulankaënsis. Their taxonomy, ecology, distribution and relationships are discussed, and a key to species is provided. Based on our phylogeny and morphological data the species were placed in section Bovini.

Evaluation of nano-technology-modified zirconia oral implants: a study in rabbits.

OBJECTIVE: The objective of this study was to screen candidate nano-technology-modified, micro-structured zirconia implant surfaces relative to local bone formation and osseointegration. MATERIALS AND METHODS: Proprietary nano-technology surface-modified (calcium phosphate: CaP) micro-structured zirconia implants (A and C), control micro-structured zirconia implants (ZiUnite), and titanium porous oxide implants (TiUnite) were implanted into the femoral condyle in 40 adult male New Zealand White rabbits. Each animal received one implant in each hind leg; thus, 20 animals received A and C implants and 20 animals received ZiUnite and TiUnite implants in contralateral hind legs. Ten animals/group were euthanized at weeks 3 and 6 when biopsies of the implant sites were processed for histometric analysis using digital photomicrographs produced using backscatter scanning electron microscopy. RESULTS: The TiUnite surface demonstrated significantly greater bone-implant contact (BIC) (77.6+/-2.6%) compared with the A (64.6+/-3.6%) and C (62.2+/-3.1%) surfaces at 3 weeks (p<0.05). Numerical differences between ZiUnite (70.5+/-3.1%) and A and C surfaces did not reach statistical significance (p>0.05). Similarly, there were non-significant differences between the TiUnite and the ZiUnite surfaces (p>0.05). At 6 weeks, there were no significant differences in BIC between the TiUnite (67.1+/-4.2%), ZiUnite (69.7+/-5.7%), A (68.6+/-1.9%), and C (64.5+/-4.1%) surfaces (p>0.05). CONCLUSION: TiUnite and ZiUnite implant surfaces exhibit high levels of osseointegration that, in this model, confirm their advanced osteoconductive properties. Addition of CaP nano-technology to the ZiUnite surface does not enhance the already advanced osteoconductivity displayed by the TiUnite and ZiUnite implant surfaces.

Ethically acceptable prioritisation of childless couples and treatment rationing: "accountability for reasonableness".

OBJECTIVE: With in vitro fertilisation serving as a specific case, an intervention was aimed at investigating the potential for applying prioritisation theories and methods in a real-life situation to form an evidence-based proposal that met the standards of the "Accountability for Reasonableness" Model. In turn, this case would serve as a basis for public decision on rationalisation, prioritisation and rationing, whereby given resources are allocated with respect to the ethical template of the Swedish Parliament's decision on priorities in health care. STUDY DESIGN: Management representatives of the overall county council as well as the gynaecologic-obstetric department levels, infertility treatment professionals and a patients' organisation representative worked together to create guidelines building on the ethical principles of human dignity, needs/solidarity and cost-effectiveness, on evidence of treatment effect, epidemiology and economic resources availability. Also quality improvement techniques were used. RESULTS: Due to new guidelines for priority setting, it is expected that more childless couples in the studied health care region will get publicly financed IVF treatment. IVF treatment outcome is expected to be more cost-effective in terms of pregnancies for a given amount of resources. A balance between needs - as defined by the guidelines' criteria - and resources is expected and thus waiting lists are expected to vanish. The patients' organisations representative accepted the guidelines. They were also accepted by all obstetric clinics and formally agreed upon by the political boards of all county councils in the region. CONCLUSION: Use of a deliberative decisions model, structured quality improvement methodology and an accepted model for prioritisation helped create a system for legitimate prioritisation of couples and rationing of treatment regarding a group of patients where differentiation has been considered difficult.

In vivo registration of force development with ceramic and acrylic resin occlusal materials on implant-supported prostheses.

PURPOSE: It has been hypothesized that the shock generation on implant-supported prostheses during chewing should generate higher implant loads if the veneering material is porcelain rather than acrylic resin. MATERIALS AND METHODS: The present study uses strain-gauged abutments to measure the force transferred to the implant after a shock has been applied. This was measured in vitro and in vivo in 5 patients. RESULTS: The different occlusal materials did not lead to different forces generated to the implants of the patients. DISCUSSION: From a practical point of view, the choice of occlusal material has no bearing per se on force generation to the implants. CONCLUSIONS: The present study demonstrated that there: (a) is a difference in resilience between acrylic resin and ceramic veneering materials, but (b) this difference is only measurable in in vitro where the force is generated by a shock only and the implant is rigidly anchored.