Characteristics of successful interventions to reduce turnover and increase retention of early career nurses: a systematic review

Background nurse shortages have been identified as central to workforce issues in healthcare systems globally and although interventions to increase the nursing workforce have been implemented, nurses leaving their roles, particularly in the first year after qualification, present a significant barrier to building the nurse workforce. Objective to evaluate the characteristics of successful interventions to promote retention and reduce turnover of early career nurses. Design this is a systematic review Data sources Online databases including Academic Search Complete, Medline, Health Policy reference Centre, EMBASE, Psychinfo, CINAHL and the Cochran Library were searched to identify relevant publications in English published between 2001 and April 2018. Studies included evaluated an intervention to increase retention or reduce turnover and used turnover or retention figures as a measure. Review methods The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were quality-assessed using the Joanna Briggs Institute Critical Appraisal tools for Quasi Experimental and Randomised Controlled Trials. Retention/turnover data were used to guide the comparison between studies and appropriate measures of central tendency and dispersion were calculated and presented, based on the normality of the data. Results A total of 11, 656 papers were identified, of which 53 were eligible studies. A wide variety of interventions and components within those interventions were identified to improve nurse retention. Promising interventions appear to be either internship/residency programmes or orientation/transition to practice programmes, lasting between 27-52 weeks, with a teaching and preceptor and mentor component. Conclusions Methodological issues impacted on the extent to which conclusions could be drawn, even though a large number of studies were identified. Future research should focus on standardising the reporting of interventions and outcome measures used to evaluate these interventions and carrying out further research with rigorous methodology. Clinical practice areas are recommended to assess their current interventions against the identified criteria to guide development of their effectiveness. Evaluations of cost-effectiveness are considered an important next step to maximise return on investment

Intermediate range chemical ordering of cations in simple molten alkali halides

The presence of first sharp diffraction peaks in the partial structure factors is investigated in computer simulations of molten mixtures of alkali halides. An intermediate range ordering appears for the Li+ ions only, which is associated with clustering of this species and is not reflected in the arrangement of other ions. This ordering is surprising in view of the simplicity of the interionic interactions in alkali halides. The clustering reflects an incomplete mixing of the various species on a local length scale, which can be demonstrated by studying the complementary sub-space of cations in the corresponding pure alkali halides by means of a void analysis.Comment: 5 pages, 5 figure

The cytoplasmic domain of CD4 promotes the development of CD4 lineage T cells.

Thymocytes must bind major histocompatibility complex (MHC) proteins on thymic epithelial cells in order to mature into either CD8+ cytotoxic T cells or CD4+ helper T cells. Thymic precursors express both CD8 and CD4, and it has been suggested that the intracellular signals generated by CD8 or CD4 binding to class I or II MHC, respectively, might influence the fate of uncommitted cells. Here we test the notion that intracellular signaling by CD4 directs the development of thymocytes to a CD4 lineage. A hybrid protein consisting of the CD8 extracellular and transmembrane domains and the cytoplasmic domain of CD4 (CD884) should bind class I MHC but deliver a CD4 intracellular signal. We find that expression of a hybrid CD884 protein in thymocytes of transgenic mice leads to the development of large numbers of class I MHC-specific, CD4 lineage T cells. We discuss these results in terms of current models for CD4 and CD8 lineage commitment

Information requirements for supersonic transport operation Final report

Effects of meteorological parameters and instrument errors on vertical flight performance of supersonic transport

Adoption and Influence: Industry Evaluation of the GrassGro\u3csup\u3eTM\u3c/sup\u3e Decision Support Tool

The GrassGro Decision Support tool (DS tool) (Donnelly and Moore, 1999) was released for commercial use in Australia with a training package in late 1997. An assessment of its adoption was made by a survey of 53 registered users in March 1999. An evaluation of the software and training package was made at training workshops by 92 users between 1997 and December 1999. The response rates to the survey and the evaluation were 62% and 82% respectively. Seventy six percent of survey respondents had analysed at least one problem with GrassGro and 27% had applied GrassGro to five or more problems encountered in the management of grazing enterprises. Users valued training highly and on completion were confident in their use of GrassGro; 63% of repondents had extrapolated the results of their analyses to a district or regional level

Are the stars of a new class of variability detected in NGC~3766 fast rotating SPB stars?

A recent photometric survey in the NGC~3766 cluster led to the detection of stars presenting an unexpected variability. They lie in a region of the Hertzsprung-Russell (HR) diagram where no pulsation are theoretically expected, in between the $\delta$ Scuti and slowly pulsating B (SPB) star instability domains. Their variability periods, between $\sim$0.1--0.7~d, are outside the expected domains of these well-known pulsators. The NCG~3766 cluster is known to host fast rotating stars. Rotation can significantly affect the pulsation properties of stars and alter their apparent luminosity through gravity darkening. Therefore we inspect if the new variable stars could correspond to fast rotating SPB stars. We carry out instability and visibility analysis of SPB pulsation modes within the frame of the traditional approximation. The effects of gravity darkening on typical SPB models are next studied. We find that at the red border of the SPB instability strip, prograde sectoral (PS) modes are preferentially excited, with periods shifted in the 0.2--0.5~d range due to the Coriolis effect. These modes are best seen when the star is seen equator-on. For such inclinations, low-mass SPB models can appear fainter due to gravity darkening and as if they were located between the $\delta$~Scuti and SPB instability strips.Comment: 6 pages, 2 figures, to appear in the proceedings of the IAU Symposium 307, New windows on massive stars: asteroseismology, interferometry, and spectropolarimetr

High-pressure behaviour of GeO2: a simulation study

In this work we study the high pressure behaviour of liquid and glassy GeO2 by means of molecular dynamics simulations. The interaction potential, which includes dipole polarization effects, was parameterized from first-principles calculations. Our simulations reproduce the most recent experimental data to a high degree of precision. The proportion of the various GeOn polyhedra is determined as a function of the pressure: a smooth transition from tetrahedral to octahedral network is observed. Finally, the study of high-pressure, liquid germania confirms that this material presents an anomalous behaviour of the diffusivity as observed in analog systems such as silica and water. The importance of penta-coordinated germanium ions for such behaviour is stressed.Comment: 16 pages, 4 figures, accepted as a Fast Track Communication on Journal of Physics: Condensed Matte

Potential implications of practice effects in Alzheimer's disease prevention trials.

IntroductionPractice effects (PEs) present a potential confound in clinical trials with cognitive outcomes. A single-blind placebo run-in design, with repeated cognitive outcome assessments before randomization to treatment, can minimize effects of practice on trial outcome.MethodsWe investigated the potential implications of PEs in Alzheimer's disease prevention trials using placebo arm data from the Alzheimer's Disease Cooperative Study donepezil/vitamin E trial in mild cognitive impairment. Frequent ADAS-Cog measurements early in the trial allowed us to compare two competing trial designs: a 19-month trial with randomization after initial assessment, versus a 15-month trial with a 4-month single-blind placebo run-in and randomization after the second administration of the ADAS-Cog. Standard power calculations assuming a mixed-model repeated-measure analysis plan were used to calculate sample size requirements for a hypothetical future trial designed to detect a 50% slowing of cognitive decline.ResultsOn average, ADAS-Cog 13 scores improved at first follow-up, consistent with a PE and progressively worsened thereafter. The observed change for a 19-month trial (1.18 points) was substantively smaller than that for a 15-month trial with 4-month run-in (1.79 points). To detect a 50% slowing in progression under the standard design (i.e., a 0.59 point slowing), a future trial would require 3.4 times more subjects than would be required to detect the comparable percent slowing (i.e., 0.90 points) with the run-in design.DiscussionAssuming the improvement at first follow-up observed in this trial represents PEs, the rate of change from the second assessment forward is a more accurate representation of symptom progression in this population and is the appropriate reference point for describing treatment effects characterized as percent slowing of symptom progression; failure to accommodate this leads to an oversized clinical trial. We conclude that PEs are an important potential consideration when planning future trials

Velocity profiles in shear-banding wormlike micelles

Using Dynamic Light Scattering in heterodyne mode, we measure velocity profiles in a much studied system of wormlike micelles (CPCl/NaSal) known to exhibit both shear-banding and stress plateau behavior. Our data provide evidence for the simplest shear-banding scenario, according to which the effective viscosity drop in the system is due to the nucleation and growth of a highly sheared band in the gap, whose thickness linearly increases with the imposed shear rate. We discuss various details of the velocity profiles in all the regions of the flow curve and emphasize on the complex, non-Newtonian nature of the flow in the highly sheared band.Comment: 4 pages, 5 figures, submitted to Phys. Rev. Let