Interventions to Reduce Adult Nursing Turnover: A Systematic Review of Systematic Reviews.

Background: Nurse turnover is an issue of concern in health care systems internationally. Understanding which interventions are effective to reduce turnover rates is important to managers and health care organisations. Despite a plethora of reviews of such interventions, strength of evidence is hard to determine. Objective: We aimed to review literature on interventions to reduce turnover in nurses working in the adult health care services in developed economies. Method: We conducted an overview (systematic review of systematic reviews) using the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, Applied Social Sciences Index and Abstracts, CINAHL plus and SCOPUS and forward searching. We included reviews published between 1990 and January 2015 in English. We carried out parallel blinded selection, extraction of data and assessment of bias, using the Assessment of Multiple Systematic Reviews. We carried out a narrative synthesis. Results: Despite the large body of published reviews, only seven reviews met the inclusion criteria. These provide moderate quality review evidence, albeit from poorly controlled primary studies. They provide evidence of effect of a small number of interventions which decrease turnover or increase retention of nurses, these being preceptorship of new graduates and leadership for group cohesion. Conclusion: We highlight that a large body of reviews does not equate with a large body of high quality evidence. Agreement as to the measures and terminology to be used together with well-designed, funded primary research to provide robust evidence for nurse and human resource managers to base their nurse retention strategies on is urgently required

A Quartz-bearing Orthopyroxene-rich Websterite Xenolith from the Pannonian Basin, Western Hungary: Evidence for Release of Quartz-saturated Melts from a Subducted Slab

An unusual quartz-bearing orthopyroxene-rich websterite xenolith has been found in an alkali basaltic tuff at Szigliget, Bakony-Balaton Highland Volcanic Field (BBHVF), western Hungary. Ortho- and clinopyroxenes are enriched in light rare earth elements (LREE), middle REE and Ni, and depleted in Nb, Ta, Sr and Ti compared with ortho- and clinopyroxenes occurring in either peridotite or lower crustal granulite xenoliths from the BBHVF. Both ortho- and clinopyroxenes in the xenolith contain primary and secondary silicate melt inclusions, and needle-shaped or rounded quartz inclusions. The melt inclusions are rich in SiO2 and alkalis and poor in MgO, FeO and CaO. They are strongly enriched in LREE and large ion lithophile elements, and display negative Nb, Ta and Sr anomalies, and slightly positive Pb anomalies. The xenolith is interpreted to represent a fragment of an orthopyroxene-rich body that crystallized in the upper mantle from a hybrid melt that formed by interaction of mantle peridotite with a quartz-saturated silicate melt that was released from a subducted oceanic slab. Although the exact composition of the slab melt cannot be determined, model calculations on major and trace elements suggest involvement of a metasedimentary componen

A Quartz-bearing Orthopyroxene-rich Websterite Xenolith from the Pannonian Basin, Western Hungary: Evidence for Release of Quartz-saturated Melts from a Subducted Slab

An unusual quartz-bearing orthopyroxene-rich websterite xenolith has been found in an alkali basaltic tuff at Szigliget, Bakony-Balaton Highland Volcanic Field (BBHVF), western Hungary. Ortho- and clinopyroxenes are enriched in light rare earth elements (LREE), middle REE and Ni, and depleted in Nb, Ta, Sr and Ti compared with ortho- and clinopyroxenes occurring in either peridotite or lower crustal granulite xenoliths from the BBHVF. Both ortho- and clinopyroxenes in the xenolith contain primary and secondary silicate melt inclusions, and needle-shaped or rounded quartz inclusions. The melt inclusions are rich in SiO2 and alkalis and poor in MgO, FeO and CaO. They are strongly enriched in LREE and large ion lithophile elements, and display negative Nb, Ta and Sr anomalies, and slightly positive Pb anomalies. The xenolith is interpreted to represent a fragment of an orthopyroxene-rich body that crystallized in the upper mantle from a hybrid melt that formed by interaction of mantle peridotite with a quartz-saturated silicate melt that was released from a subducted oceanic slab. Although the exact composition of the slab melt cannot be determined, model calculations on major and trace elements suggest involvement of a metasedimentary componen

Some closure operations in Zariski-Riemann spaces of valuation domains: a survey

In this survey we present several results concerning various topologies that were introduced in recent years on spaces of valuation domains

Detection and Monitoring of Repetitions Using an mHealth-Enabled Resistance Band

Sarcopenia is defined as an age-related loss of muscle mass and strength which impairs physical function leading to disability and frailty. Resistance exercises are effective treatments for sarcopenia and are critical in mitigating weight-loss induced sarcopenia in older adults attempting to lose weight. Yet, adherence to home-based regimens, which is a cornerstone to lifestyle therapies, is poor and cannot be ascertained by clinicians as no objective methods exist to determine patient compliance outside of a supervised setting. Our group developed a Bluetooth connected resistance band that tests the ability to detect exercise repetitions. We recruited 6 patients aged 65 years and older and recorded 4 specific, physical therapist-led exercises. Three blinded reviewers examined the findings and we also applied a peak finding algorithm to the data. There were 16.6 repetitions per exercise across reviewers, with an intraclass correlation of 0.912 (95%CI: $0.853-0.953$, $p\u3c0.001$) between reviewers and the algorithm. Using this novel resistance band, we feasibly detected repetition of exercises in older adults. Sarcopenia is defined as an age-related loss of muscle mass and strength which impairs physical function leading to disability and frailty. Resistance exercises are effective treatments for sarcopenia and are critical in mitigating weight-loss induced sarcopenia in older adults attempting to lose weight. Yet, adherence to home-based regimens, which is a cornerstone to lifestyle therapies, is poor and cannot be ascertained by clinicians as no objective methods exist to determine patient compliance outside of a supervised setting. Our group developed a Bluetooth connected resistance band that tests the ability to detect exercise repetitions. We recruited 6 patients aged 65 years and older and recorded 4 specific, physical therapist-led exercises. Three blinded reviewers examined the findings and we also applied a peak finding algorithm to the data. There were 16.6 repetitions per exercise across reviewers, with an intraclass correlation of 0.912 (95%CI: $0.853-0.953$, $p\u3c0.001$) between reviewers and the algorithm. Using this novel resistance band, we feasibly detected repetition of exercises in older adults

Sharks of the order Carcharhiniformes from the British Coniacian, Santonian and Campanian (Upper Cretaceous).

Bulk sampling of phosphate-rich horizons within the British Coniacian to Campanian (Upper Cretaceous) yielded very large samples of shark and ray teeth. All of these samples yielded teeth of diverse members of the Carcharhiniformes, which commonly dominate the fauna. The following species are recorded and described: Pseudoscyliorhinus reussi (Herman, 1977) comb. nov., Crassescyliorhinus germanicus (Herman, 1982) gen. nov., Scyliorhinus elongatus (Davis, 1887), Scyliorhinus brumarivulensis sp. nov., ? Palaeoscyllium sp., Prohaploblepharus riegrafi (Müller, 1989) gen. nov., ? Cretascyliorhinus sp., Scyliorhinidae inc. sedis 1, Scyliorhinidae inc. sedis 2, Pteroscyllium hermani sp. nov., Protoscyliorhinus sp., Leptocharias cretaceus sp. nov., Palaeogaleus havreensis Herman, 1977, Paratriakis subserratus sp. nov., Paratriakis tenuis sp. nov., Paratriakis sp. indet. and ? Loxodon sp. Taxa belonging to the families ?Proscylliidae, Leptochariidae, and Carcharhinidae are described from the Cretaceous for the first time. The evolutionary and palaeoecological implications of these newly recognised faunas are discussed

The phylogenetically-related pattern recognition receptors EFR and XA21 recruit similar immune signaling components in monocots and dicots

During plant immunity, surface-localized pattern recognition receptors (PRRs) recognize pathogen-associated molecular patterns (PAMPs). The transfer of PRRs between plant species is a promising strategy for engineering broad-spectrum disease resistance. Thus, there is a great interest in understanding the mechanisms of PRR-mediated resistance across different plant species. Two well-characterized plant PRRs are the leucine-rich repeat receptor kinases (LRR-RKs) EFR and XA21 from Arabidopsis thaliana (Arabidopsis) and rice, respectively. Interestingly, despite being evolutionary distant, EFR and XA21 are phylogenetically closely related and are both members of the sub-family XII of LRR-RKs that contains numerous potential PRRs. Here, we compared the ability of these related PRRs to engage immune signaling across the monocots-dicots taxonomic divide. Using chimera between Arabidopsis EFR and rice XA21, we show that the kinase domain of the rice XA21 is functional in triggering elf18-induced signaling and quantitative immunity to the bacteria Pseudomonas syringae pv. tomato (Pto) DC3000 and Agrobacterium tumefaciens in Arabidopsis. Furthermore, the EFR:XA21 chimera associates dynamically in a ligand-dependent manner with known components of the EFR complex. Conversely, EFR associates with Arabidopsis orthologues of rice XA21-interacting proteins, which appear to be involved in EFR-mediated signaling and immunity in Arabidopsis. Our work indicates the overall functional conservation of immune components acting downstream of distinct LRR-RK-type PRRs between monocots and dicots

Inapplicability of advance directives in a paternalistic setting: the case of a post-communist health system

<p>Abstract</p> <p>Background</p> <p>The Albanian medical system and Albanian health legislation have adopted a paternalistic position with regard to individual decision making. This reflects the practices of a not-so-remote past when state-run facilities and a totalitarian philosophy of medical care were politically imposed. Because of this history, advance directives concerning treatment refusal and do-not-resuscitate decisions are still extremely uncommon in Albania. Medical teams cannot abstain from intervening even when the patient explicitly and repeatedly solicits therapeutic abstinence. The Albanian law on health care has no provisions regarding limits or withdrawal of treatment. This restricts the individual's healthcare choices.</p> <p>Discussion</p> <p>The question of <it>'medically futile' </it>interventions and pointless life-prolonging treatment has been discussed by several authors. Dutch physicians call such interventions '<it>medisch zinloos</it>' (<it>senseless</it>), and the Netherlands, as one of the first states to legislate on end-of-life situations, actually regulates such issues through appropriate laws. In contrast, leaving an 'advance directive' is not a viable option for Albanian ailing individuals of advanced age. Verbal requests are provided during periods of mental competence, but unfortunately such instructions are rarely taken seriously, and none of them has ever been upheld in a legal or other official forum.</p> <p>Summary</p> <p>End-of-life decisions, treatment refusal and do-not-resuscitate policies are hazardous options in Albania, from the legal point of view. Complying with them involves significant risk on the part of the physician. Culturally, the application of such instructions is influenced from a mixture of religious beliefs, death coping-behaviors and an immense confusion concerning the role of proxies as decision-makers. Nevertheless, Albanian tradition is familiar with the notion of '<it>amanet</it>', a sort of living will that mainly deals the property and inheritance issues. Such living wills, verbally transmitted, may in certain cases include advance directives regarding end-of-life decisions of the patient including refusal or termination of futile medical treatments. Since these living wills are never formally and legally validated, their application is impossible and treatment refusal remains still non practicable. Tricks to avoid institutional treatment under desperate conditions are used, aiming to provide legal coverage for medical teams and relatives that in extreme situations comply with the advice of withholding senseless treatment.</p

Subinhibitory Arsenite Concentrations Lead to Population Dispersal in Thiomonas sp.

Biofilms represent the most common microbial lifestyle, allowing the survival of microbial populations exposed to harsh environmental conditions. Here, we show that the biofilm development of a bacterial species belonging to the Thiomonas genus, frequently found in arsenic polluted sites and playing a key role in arsenic natural remediation, is markedly modified when exposed to subinhibitory doses of this toxic element. Indeed, arsenite [As(III)] exposure led to a considerable impact on biofilm maturation by strongly increasing the extracellular matrix synthesis and by promoting significant cell death and lysis within microcolonies. These events were followed by the development of complex 3D-biofilm structures and subsequently by the dispersal of remobilized cells observed inside the previously formed hollow voids. Our results demonstrate that this biofilm community responds to arsenite stress in a multimodal way, enhancing both survival and dispersal. Addressing this complex bacterial response to As(III) stress, which might be used by other microorganisms under various adverse conditions, may be essential to understand how Thiomonas strains persist in extreme environments

Healing Potential of Picrorhiza kurroa (Scrofulariaceae) rhizomes against indomethacin-induced gastric ulceration: a mechanistic exploration.

<p>Abstract</p> <p>Background</p> <p>The present study was undertaken to evaluate the potential of the rhizomes of the Indian medicinal plant, <it>Picrorhiza kurroa </it>in healing indomethacin-induced acute stomach ulceration in mice and examine its capacity to modulate oxidative stress and the levels of prostaglandin (PGE₂) and EGF during the process.</p> <p>Methods</p> <p>Male swiss albino mice, ulcerated with indomethacin (18 mg/kg, p. o., single dose) were treated up to 7 days with different doses of the methanol extract of <it>P. kurroa </it>rhizomes (designated as PK). The healing capacity of the most effective dose of PK (20 mg/kg, p. o. × 3 d) was compared with that of omeprazole (Omez) (3 mg/kg, p. o. × 3 d). The effects of the drug-treatment for one and three days on the biochemical parameters were assessed by comparing the results with that of untreated mice of the 1^stand 3^rdday of ulceration. The stomach tissues of the mice were used for the biochemical analysis.</p> <p>Results</p> <p>The macroscopic indices revealed maximum ulceration on the 3^rdday after indomethacin administration, which was effectively healed by PK. Under the optimized treatment regime, PK and Omez reduced the ulcer indices by 45.1% (<it>P </it>< 0.01), and 76.3% respectively (<it>P </it>< 0.001), compared to the untreated ulcerated mice.</p> <p>Compared to the ulcerated untreated mice, those treated with PK for 3 days showed decreased the levels of thiobarbituric acid reactive substances (TBARS) (32.7%, <it>P </it>< 0.05) and protein carbonyl (37.7%, <it>P </it>< 0.001), and increased mucin (42.2%, <it>P </it>< 0.01), mucosal PGE₂(21.4%, <it>P </it>< 0.05), and expressions of COX-1 and 2 (26.9% and 18.5%, <it>P </it>< 0.05), EGF (149.0%, <it>P </it>< 0.001) and VEGF (56.9%, <it>P </it>< 0.01). Omez reduced the TBARS (29.4%, <it>P </it>< 0.05), and protein carbonyl (38.9%, <it>P </it>< 0.001), and increased mucin (38.3%, <it>P </it>< 0.01), without altering the other parameters significantly.</p> <p>Conclusion</p> <p>PK (20 mg/kg, p. o. × 3 days) could effectively heal indomethacin-induced stomach ulceration in mice by reducing oxidative stress, and promoting mucin secretion, prostaglandin synthesis and augmenting expressions of cyclooxygenase enzymes and growth factors.</p