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BACKGROUND: Hand hygiene compliance even before infection-prone procedures (indication 2, 'before aseptic tasks', according to the World Health Organization (WHO)) remains disappointing. AIM: To improve hand hygiene compliance by implementing gloved hand disinfection as a resource-neutral process optimization strategy. METHODS: We performed a three-phase intervention study on a stem cell transplant ward. After baseline evaluation of hand hygiene compliance (phase 1) gloved hand disinfection was allowed (phase 2) and restricted (phase 3) to evaluate and differentiate intervention derived from learning and time effects. The incidence of severe infections as well as of hospital-acquired multidrug-resistant bacteria was recorded by active surveillance. FINDINGS: Hand hygiene compliance improved significantly from 50% to 76% (P < 0.001) when gloved hand disinfection was allowed. The biggest increase was for infection-prone procedures (WHO 2) from 31% to 65%; P < 0.001. Severe infections decreased by trend (from 6.0 to 2.5 per 1000 patient-days) whereas transmission of multidrug-resistant organisms was not affected. CONCLUSION: Gloved hand disinfection significantly improved compliance with the hand hygiene, especially in activities relevant to infections and infection prevention. Thus, this process optimization may be an additional, easy implementable, resource-neutral tool for a highly vulnerable patient cohort.

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Ultra-low-field (ULF) nuclear magnetic resonance (NMR) is a promising spectroscopy method allowing for, e.g., the simultaneous detection of multiple nuclei. To overcome the low signal-to-noise ratio that usually hampers a wider application, we present here an alternative approach to ULF NMR, which makes use of the hyperpolarizing technique signal amplification by reversible exchange (SABRE). In contrast to standard parahydrogen hyperpolarization, SABRE can continuously hyperpolarize 1 H as well as other MR-active nuclei. For simultaneous measurements of 1 H and 19 F under SABRE conditions a superconducting quantum interference device (SQUID)-based NMR detection unit was adapted. We successfully hyperpolarized fluorinated pyridine derivatives with an up to 2000-fold signal enhancement in 19 F. The detected signals may be explained by two alternative reaction mechanisms. SABRE combined with simultaneous SQUID-based broadband multinuclear detection may enable the quantitative analysis of multinuclear processes.

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BACKGROUND: Myocardial dysfunction is a well-documented outcome of extended periods of high cardiac output. Whether similar effects occur during firefighting, an occupation characterized by repeated periods of work compounded by dehydration and heat stress, is uncertain. AIMS: To investigate the independent and combined effects of moderate heat stress and dehydration on indicators of myocardial performance following intermittent, submaximal treadmill exercise while wearing personal protective equipment (PPE). METHODS: Twelve aerobically fit young men (age 21.5±2.6 years; maximal oxygen uptake [VO2max] 60.3±4.4ml kg(-1) min(-1)) performed intermittent treadmill walking exercise consisting of three 20min bouts at an intensity of ~40% VO2max separated by two periods of rest in four different conditions in random order: (i) no heat stress-euhydrated, (ii) heat stress-euhydrated (heat stress created by wearing PPE, (iii) no heat stress-dehydrated and (iv) heat stress-dehydrated. We measured core temperature by a telemetric gastrointestinal pill. We determined cardiac variables by standard echocardiographic techniques immediately before and ~30min after exercise. RESULTS: We recorded no significant changes in markers of systolic (ejection fraction, shortening fraction, tissue Doppler-S) or diastolic (mitral peak E velocity, tissue Doppler-E' and E/E') function following exercise in any of the four conditions. CONCLUSIONS: In this model of exercise designed to mimic the work, heat stress and dehydration associated with firefighting activities, we observed no negative effects on myocardial inotropic or lusitropic function.

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Organ procurement coordinators (coordinators) employed by organ procurement organizations (OPOs) are critical to the success of organ donation. However, their high turnover rates may threaten the success of organ donation. This cross-sectional study examined employment satisfaction and factors contributing to job turnover among 326 coordinators representing 52 of 58 OPOs (90%) who completed an online survey. Most (93%) respondents reported high levels of job satisfaction, although 26% reported considering leaving their OPO, and 61% perceived a high turnover rate at their OPO. Considerations of leaving the OPO were most likely to emerge at 2 years of employment. To secure coordinator job satisfaction, it is essential that prospective coordinators be adequately prepared and informed about negative as well as positive aspects of this line of work. In hiring, OPOs should recruit more proactively, using their staff as contacts, and seek experience in critical care, intensive care, or other on-call work. To retain satisfied employees, OPOs should offer more education and advancement opportunities and focus on such issues as call and hours, rather than salary per se. OPOs should consider a variety of alternative pay structures, particularly separate on-call pay, whether or not coordinators are actually called into service.

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OBJECTIVES: The objectives of this study were to 1) assess volumetric bone geometry and density at the distal radius of individuals with chronic stroke and 2) assess whether bone strength is associated with measures of muscle strength and impairment. MATERIAL AND METHODS: Cross-sectional study of bone and muscle parameters in 15 community-dwelling people living with the residual effects of a stroke (between 1 and 9 years post-incident stroke). RESULTS: The 4% site of the distal radius had significantly lower bone mineral content and density on the paretic side (p<0.006). There was a significant difference in pQCT measures of bone cortical density (p<0.03), area (p<0.05) and bone strength [Stress-Strain Index; SSI] (p<0.01) (lower on the paretic side) at the 30%. We found significant correlations between composite muscle strength score of the upper extremities and pQCT-generated bone strength. CONCLUSIONS: This cross-sectional study highlights lower bone strength on the paretic limb and an adaptive response to disuse.

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The purpose of this study was to examine the intra-tester and inter-tester reliability of strain gauge plethysmography (SGP) using the Hokanson EC-5R plethysmograph among three investigators. An arterial inflow test was performed by each of the investigators on fifteen college-aged volunteers at the forearm and calf sites. Intra-tester reliability was assessed by analyzing three serial measurements obtained at both sites. Intertester reliability was assessed in two ways: first, by having the three investigators obtain and analyze their own recordings, and, second, by having all three investigators (Testers 1, 2, and 3) analyze SGP recordings obtained by the most experienced investigator (Tester 1). The mean coefficient of variation (CV) for the intra-tester analysis was similar at the forearm (4.9%) and calf (4.0%) sites. The inter-tester analysis revealed that there were no significant differences among the three testers at either site when investigators obtained and analyzed their own waveforms. The CV calculated from the means of the three investigators was greater at the forearm site (10.7%) than at the calf site (2.5%). Similarly, when Testers 2 and 3 analyzed Tester 1's waveforms there were no significant differences found among testers at either site and the CV was less than when each investigator obtained his/her own waveforms. Strain gauge plethysmography blood flow measures obtained by experienced testers, under controlled laboratory conditions, are reproducible. The small variability in blood flow that exists is more attributable to variability in the acquisition of the waveforms than in the analysis of the waveforms.

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PURPOSE: The purpose of this study was to compare two commercially available accelerometers with indirect calorimetry in a group of older adults (x +/- SD; 70.6+/-3.7 yr; N = 86, 44 males and 42 females). METHODS: The accelerometers (Caltrac and Tritrac, Hemokinetics, Madison, WI) were worn while performing three submaximal, discontinuous (5 min exercise, 2 min recovery), progressive levels of treadmill walking and bench stepping. The treadmill exercise averaged 3.4 mph, at 0.4% grade, 3.0% grade, and 5.1% grade, while the stepping work rates (24 steps x min(-1)) were performed on 15.2-, 20.3-, and 25.4-cm steps. Estimated energy expenditure (EE) from the two accelerometers was compared with EE as measured by indirect calorimetry. RESULTS: The Caltrac significantly (P < 0.05) overestimated EE at the three treadmill work rates (10-52% difference) and underestimated EE at the three stepping work rates (-19% to -28% difference). When comparing the changes in EE between work rates one, two and three, the Caltrac was not sensitive to the changes (increase in EE) that occurred during graded treadmill walking but did detect some changes in the stepping exercise. The Tritrac significantly (P < 0.05) underestimated EE for the three work rates of both the treadmill and stepping exercise when compared with indirect calorimetry but did detect differences in EE among work rates during stepping exercise (P < 0.05). CONCLUSIONS: These data indicate that the magnitude of the differences between measured and estimated EE is affected by exercise mode and intensity and that caution is warranted when using the accelerometers in an attempt to quantify EE in older adults.

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BACKGROUND: The ability to take a patient's temperature quickly, easily, and accurately is desirable in a variety of situations. However, in order to have confidence in the values obtained, it is important to quantify the reliability of the measurement. PURPOSE: The purpose of this study, therefore, was to determine the reliability of temperature measurements obtained by infra-red tympanic membrane thermometers. METHOD: This study examined intra-tester, inter-tester and inter-instrument reliability using two commercially available tympanic membrane thermometers. Forty-four college students (mean age 20.2 +/- 3.6 yr) had their tympanic membrane temperature taken by two investigators, each using two different instruments (ThermoScan Pro-1 and FirstTemp Genius). RESULTS: The results indicated a statistically significant difference between testers for each instrument. Similarly, there was a significant statistical difference between instruments within each tester. Correlations were moderately high (r = 0.66-0.88) between testers for each instrument, whereas correlations within instruments varied considerably between testers (r = 0.35-0.78). The intra-tester reliability was good for both testers using both instruments with all coefficients of variation (CV) less than 2%. Statistically significant differences were found between testers for each instrument and between instruments for each tester. A 2 x 2 ANOVA revealed a significant main effect for Tester and a significant Tester x Instrument interaction. CONCLUSION: We conclude that individual investigators are able to obtain reliable temperature measures when using either the FirstTemp Genius or ThermoScan Pro-1 instruments under resting laboratory conditions. However, inter-tester and inter-instrument reliability should be considered when collecting or comparing data.

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The purpose of this cross-sectional study were to determine whether exercisers have greater bone mineral density (BMD) than nonexercisers, whether aerobic dancers have greater BMD than walkers, and to determine the contributions of energy expenditure, body composition, and dietary factors to spine and femur BMD. Measurements were obtained on 93 eumenorrheic women (walkers N = 28; aerobic dancers, N = 34; nonexercisers, N = 31) ages 25-41 yr; lumbar spine and proximal femur BMD, body composition, physical activity, and nutrient intakes. Mean height, weight, and body mass index and median age and calcium intakes were similar for the three groups. Mean (+/- SD) values of the spine, total femur, and femoral neck BMD, respectively, were: walkers (1.092 (+/- 0.098), 0.947 g.cm-2), dancers (1.070 (+/- 0.124), 0.990 (+/- 0.104), 0.908 (+/- 0.106) g.cm-2), and nonexercisers (1.020 (+/- 0.112), 0.887 (+/- 0.073), 0.792 (+/- 0.089) g.cm-2) multiple regression analyses indicated that exercise contributed to spine (P = 0.018), total femur (P =0.012), and femoral neck (P < 0.0001) BMD, whereas type of exercise (aerobic dance vs walking) did not (P > 0.05). Total femoral BMD was influenced by exercise (P = 0.012) and energy expenditure (P = 0.023), while vertebral BMD was influenced by age (P = 0.0067), body weight (P = 0.017), and exercise (P = 0.018). These findings suggest that walking and aerobic dance exercise may provide physically active premenopausal women with greater lumbar and femoral BMD than sedentary females.

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The purpose of this study was to compare bone mineral densities (BMD) of collegiate female athletes who compete in impact loading sports; volleyball players (N = 8) and gymnasts (N = 13), to a group of athletes who participate in an active loading sport; swimmers (N = 7), and a group of controls (N = 17). All of the volleyball, swimming, and control subjects were eumenorrheic (10-12 cycles/year), whereas two of the gymnasts were amenorrheic (0-3 cycles/year), eight were oligomenorrheic (4-8 cycles/year), and three were eumenorrheic (10-12 cycles/year). Lumbar spine, proximal femur, and total body BMD were measured with dual-energy X-ray absorptiometry. The groups were compared with respect to the following regions: lumbar spine (L1-4); femoral neck; Ward's triangle; right and left arms; right and left legs; pelvis; and torso. When controlling for differences in height and weight the impact loading group (volleyball and gymnastic) had significantly greater BMD at the lumbar spine, femoral neck, Ward's Triangle, and total body when compared to the active loading (swimming) and control groups. The regional analysis from the total body scan revealed that the gymnasts had significantly (p < 0.05) greater BMD than all other groups at the right and left arm sites. The impact loading groups (gymnastic and volleyball) had a greater BMD in the legs and pelvis than the active loading (swimming) and control groups. Furthermore, the impact loading group had a greater torso BMD than the control group. There were no differences at any site between the active loading group (swimming) and control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

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