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

The {\gamma} Dor stars as revealed by Kepler : A key to reveal deep-layer rotation in A and F stars

The {\gamma} Dor pulsating stars present high-order gravity modes, which make them important targets in the intermediate-and low-mass main-sequence region of the Hertzsprung-Russell diagram. Whilst we have only access to rotation in the envelope of the Sun, the g modes of {\gamma} Dor stars can in principle deliver us constraints on the inner layers. With the puzzling discovery of unexpectedly low rotation rates in the core of red giants, the {\gamma} Dor stars appear now as unique targets to explore internal angular momentum transport in the progenitors of red giants. Yet, the {\gamma} Dor pulsations remain hard to detect from the ground for their periods are close to 1 day. While the CoRoT space mission first revealed intriguing frequency spectra, the almost uninterrupted 4-year photometry from the Kepler mission eventually shed a new light on them. It revealed regularities in the spectra, expected to bear signature of physical processes, including rotation, in the shear layers close to the convective core. We present here the first results of our effort to derive exploitable seismic diagnosis for mid- to fast rotators among {\gamma} Dor stars. We confirm their potential to explore the rotation history of this early phase of stellar evolution.Comment: 4 pages, 1 figure, proceedings of the 22nd Los Alamos Stellar Pulsation Conference, "Wide-field variability surveys: a 21st-century perspective" held in San Pedro de Atacama, Chile, Nov. 28-Dec. 2, 201

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

Determining the metallicity of the solar envelope using seismic inversion techniques

The solar metallicity issue is a long-lasting problem of astrophysics, impacting multi- ple fields and still subject to debate and uncertainties. While spectroscopy has mostly been used to determine the solar heavy elements abundance, helioseismologists at- tempted providing a seismic determination of the metallicity in the solar convective enveloppe. However, the puzzle remains since two independent groups prodived two radically different values for this crucial astrophysical parameter. We aim at provid- ing an independent seismic measurement of the solar metallicity in the convective enveloppe. Our main goal is to help provide new information to break the current stalemate amongst seismic determinations of the solar heavy element abundance. We start by presenting the kernels, the inversion technique and the target function of the inversion we have developed. We then test our approach in multiple hare-and-hounds exercises to assess its reliability and accuracy. We then apply our technique to solar data using calibrated solar models and determine an interval of seismic measurements for the solar metallicity. We show that our inversion can indeed be used to estimate the solar metallicity thanks to our hare-and-hounds exercises. However, we also show that further dependencies in the physical ingredients of solar models lead to a low accuracy. Nevertheless, using various physical ingredients for our solar models, we determine metallicity values between 0.008 and 0.014.Comment: Accepted for publication in MNRA

Surface compositional mapping by spectral ratioing of ERTS-1 MSS data in the Wind River Basin and Range, Wyoming

The author has identified the following significant results. ERTS data collected in August and October 1972 were processed on digital and special purpose analog recognition computers using ratio enhancement and pattern recognition. Ratios of band-averaged laboratory reflectances of some minerals and rock types known to be in the scene compared favorably with ratios derived from the data by ratio normalization procedures. A single ratio display and density slice of the visible channels of ERTS MSS data, Channel 5/Channel 4 (R5,4), separated the Triassic Chugwater formation (redbeds) from other formations present and may have enhanced iron oxide minerals present at the surface in abundance. Comparison of data sets collected over the same area at two different times of the year by digital processing indicated that spectral variation due to environmental factors was reduced by ratio processing

Preparing the sexual health workforce to deliver integrated services: is education the answer? A qualitative study exploring the impact of sexual health education on developing integrated policy and practice.

This study aimed to explore the ability of sexual health nurses working in the South West of England, to implement new learning within existing sexual health service delivery models. Drawing on Lipsky’s account of street-level bureaucracy to conceptualise policy implementation, the impact of workforce learning on the development of integrated services across this region of the United Kingdom was assessed. In order to achieve the United Nations’ goal of universal access to sexual health, it is essential for reproductive and sexual health, including HIV provision, to integrate into a single service. This integration requires a commitment to collaboration by service commissioners and an alignment of principles and values across sexual health and contraceptive services. UK health policy has embraced this holistic agenda but moves towards integrating historically separate clinical services, has presented significant workforce development challenges and influenced policy success. Employing a qualitative approach, the study included data from semi-structured telephone interviews and focus groups, and longitudinal data from pre- and post-intervention surveys, collected between September 2013 and September 2015. Data were collected from 88 nurses undertaking a workforce development programme and six of their service managers. Data were analysed using thematic analysis to identify consistent themes. Nurses confirmed the role of new learning in enabling them to negotiate the political landscape but expressed frustration at their lack of agency in the integration agenda, exposing a clear dichotomy between the intentions of policy and the reality of practice. Nevertheless, using high levels of professional judgement and discretion practitioners managed the incongruence between policy and practice in order to deliver integrated services in the interests of patients. Workforce education, while essential for the transition to the delivery of integrated services, was insufficient to fulfil the sexual health agenda without a strengthening of public health

Effects of a multi-component exercise program and calcium–vitamin-D3-fortified milk on bone mineral density in older men : a randomised controlled trial

Summary We examined the independent and combined effects of a multi-component exercise program and calcium&ndash;vitamin-D3-fortified milk on bone mineral density (BMD) in older men. Exercise resulted in a 1.8% net gain in femoral neck BMD, but additional calcium&ndash;vitamin D3 did not enhance the response in this group of older well-nourished men.Introduction This 12-month randomised controlled trial assessed whether calcium&ndash;vitamin-D3-fortified milk could enhance the effects of a multi-component exercise program on BMD in older men.Methods Men (n&thinsp; =&thinsp;180) aged 50&ndash;79 years were randomised into: (1) exercise + fortified milk; (2) exercise; (3) fortified milk; or (4) controls. Exercise consisted of high intensity progressive resistance training with weight-bearing impact exercise. Men assigned to fortified milk consumed 400 mL/day of low fat milk providing an additional 1,000 mg/day calcium and 800 IU/day vitamin D3. Femoral neck (FN), total hip, lumbar spine and trochanter BMD and body composition (DXA), muscle strength 25-hydroxyvitamin D and parathyroid hormone (PTH) were assessed.Results There were no exercise-by-fortified milk interactions at any skeletal site. Exercise resulted in a 1.8% net gain in FN BMD relative to no-exercise (p&thinsp;&lt;&thinsp;0.001); lean mass (0.6 kg, p&thinsp;&lt;&thinsp;0.05) and muscle strength (20&ndash;52%, p&thinsp;&lt;&thinsp;0.001) also increased in response to exercise. For lumbar spine BMD, there was a net 1.4&ndash;1.5% increase in all treatment groups relative to controls (all p&thinsp;&lt;&thinsp;0.01). There were no main effects of fortified milk at any skeletal site.Conclusion A multi-component community-based exercise program was effective for increasing FN BMD in older men, but additional calcium&ndash;vitamin D3 did not enhance the osteogenic response.<br /

Slow flows of an relativistic perfect fluid in a static gravitational field

Relativistic hydrodynamics of an isentropic fluid in a gravitational field is considered as the particular example from the family of Lagrangian hydrodynamic-type systems which possess an infinite set of integrals of motion due to the symmetry of Lagrangian with respect to relabeling of fluid particle labels. Flows with fixed topology of the vorticity are investigated in quasi-static regime, when deviations of the space-time metric and the density of fluid from the corresponding equilibrium configuration are negligibly small. On the base of the variational principle for frozen-in vortex lines dynamics, the equation of motion for a thin relativistic vortex filament is derived in the local induction approximation.Comment: 4 pages, revtex, no figur