Quantitative analysis of wide-field specular microscopy. II. Precision of sampling from the central corneal endothelium

The precision of the measurement of mean endothelial cell area obtained by sampling with small-field and wide-field specular microscopy from the central 4 mm of human corneal endothelium was studied by comparing endothelial cell parameters from individual specular micrographs in vivo to the results obtained by montaging the micrographs from the entire central 4 mm of the same corneas. The small samples were at least 10% from the true mean cell size of all cells of the central 4 mm in any endothelium other than that with the most homogeneous pattern. A new algorithm for sampling with these two specular microscopes will need to be derived to permit a more precise measure of the mean area of endothelial cells in the central 4 mm of the human corneal endothelium

Low circulating concentrations of very long chain saturated fatty acids are associated with high risk of mortality in kidney transplant recipients

Kidney transplant recipients (KTR) are at increased risk of mortality, particularly from infectious diseases, due to lifelong immunosuppression. Although very long chain saturated fatty acids (VLSFA) have been identified as crucial for phagocytosis and clearance of infections, their association with mortality in immunocompromised patient groups has not been studied. In this prospective cohort study we included 680 outpatient KTR with a functional graft ≥1 year and 193 healthy controls. Plasma VLSFA (arachidonic acid (C20:0), behenic acid (C22:0) and lignoceric acid (C24:0)) were measured by gas chromatography coupled with a flame ionization detector. Cox regression analyses was used to prospectively study the associations of VLSFA with all-cause and cause-specific mortality. All studied VLSFA were significantly lower in KTR compared to healthy controls (all p < 0.001). During a median (interquartile range) follow-up of 5.6 (5.2–6.3) years, 146 (21%) KTR died, of which 41 (28%) died due to infectious diseases. In KTR, C22:0 was inversely associated with risk of all-cause mortality, with a HR (95% CI) per 1-SD-increment of 0.79 (0.64–0.99), independent of adjustment for potential confounders. All studied VLSFA were particularly strongly associated with mortality from infectious causes, with respective HRs for C20:0, C22:0 and C24:0 of 0.53 (0.35–0.82), 0.48 (0.30–0.75), and 0.51 (0.33–0.80), independent of potential confounders. VLSFA are inversely associated with infectious disease mortality in KTR after adjustment, including HDL-cholesterol. Further studies are needed to assess the effect of VLSFA-containing foods on the risk of infectious diseases in immunocompromised patient groups

Factors influencing the practice of new graduate nurses : a focused ethnography of acute care settings

Aim: To explore the influence of an acute care setting on competency deployment of new graduate nurses (NGNs) from a competency -based undergraduate programme . Background: In the last 15 years, nursing education has shifted to competency -based education (CBE). Few studies have focused on how NGNs from these reformed programmes use the competencies they have developed. To be paradigmatically coherent with the nature of a competence, studies should also examine how context influences nursing practice and competency deployment. Design: A focused ethnography of three acute care units from one academic hospital in Canada. Methods: Purposive and snowball sampling strategies were used to recruit 19 participants: NGNs (n = 4), nurse preceptors (n = 2), clinical nurse specialists (n = 9) , and nurse managers (n = 4). Data were collected through individual interviews, focus groups , observation and documentation. Data were analysed according to Roper and Shapira’s (2000) ethnographic nursing analysis framework. Results: Organizational and individual factors were identified as influencing NGNs ’ competenc y deployment. Organizational factors are orientation, stability, workload, and the scientific culture of the unit. Personal factors have been linked to groups of professionals: for NGNs, personality and clinical placements during their initial education; for nurses working with NGNs, to be role models, to promote integration and to denounce bullying; and for other health professionals, to recognize nursing expertise. Conclusion: One way to s mooth the transition from academic to clinical settings for NGNs is by offering transition or orientation programmes that will provide them with stability and a reduced workload, allowing them to progressively deploy their competencies. Relevance to clinical practice: Organizational and individual factors influence how new graduate nurses deploy their competencies. Clinical educators and nurse managers can help new nurses by acting on these factors

Innerbetriebliches, schienengebundenes Transportsystem

The invention relates to a rail-bound transport system comprising self-propelled vehicles running along a rail system, fixed rail sections and movable rail sections, shunted wagons, lifts, turntables, etc. The rail-bound transport system is characterized by the vehicles having at least one bumper to prevent them travelling over open rail ends and having at least a stopping element for the fixed and movable open rail ends, which are movable between an operating point at which they stop the vehicle on contact with the bumper, and an external operating point at which they permit the passage of the vehicle, the transition of the contact element from operating point to external operating point taking place by means of an operating equipment, when a moving rail end is positioned in relation to the open fixed rail end such that a vehicle can travel over the joint position

Steering or braking avoidance response in SHRP2 rear-end crashes and near-crashes: A decision tree approach

Objective The paper presents a systematic analysis of drivers’ crash avoidance response during crashes and near-crashes and developed a machine learning-based predictive model that can determine driver maneuver using pre-incident driver behavior and driving context. Methods We analyzed 286 naturalistic rear-end crashes and near-crashes from the SHRP2 naturalistic driving study. All the events were manually reduced using face video (face and forward) and kinematic responses. In this paper, we developed new reduction variables that enhanced the understanding of drivers’ gaze behavior and roadway attention behavior during these events. These features reflected how the event criticality, measured using time to collision, related to drivers’ pre-incident behavior (secondary behavior, gaze behavior), and drivers’ perception of the event (physical reaction and maneuver). The imperative understanding of such relations was validated using a random forest- (RF) based classifier, which efficiently predicted if a driver was going to brake or change the lane as an avoidance maneuver. Results The RF presented in this paper effectively explored the nonlinear patterns in the data and was highly accurate (∼96 %) in its prediction. A further analysis of the RF model showed that six features played a pivotal role in the decision logic. These included the drivers’ last glance duration before the event, last glance eccentricity, duration of ‘eyes on road’ immediately before the event, the time instance and criticality when the driver perceives the threat as well as acknowledge the threat, and possibility of an escape path in the adjacent lane. Using partial dependency plots, we also showed how different thresholds of these feature variables determined the drivers’ maneuver intention. Conclusions In this paper we analyzed driving context, drivers’ behavior, event criticality, and drivers’ response in a unified structure to predict their avoidance response. To the best of our knowledge, this is the first such effort where large-scale naturalistic data (crashes and near crashes) was analyzed for prediction of drivers’ maneuver and determined key behavioral and contextual factors that contribute to this avoidance maneuver