Review of nursing turnover research, 1977-1996.

Turnover represents a major problem for health care services in terms of cost and quality of care given. As a result, turnover has been the subject of a large number of investigations. However, the variety of study populations, research methodologies, and inconsistent definitions and measurements of turnover lead to difficulties when attempting to compare studies. The purpose of this paper is to present: (1) a summary of turnover study methods and procedures, and (2) a summary of socio-demographic, organizational, and social support factors associated with turnover of nursing staff.

Ulysses solar wind plasma observations at high southerly latitudes.

Solar wind plasma observations made by the Ulysses spacecraft through -80.2 degrees solar latitude and continuing equatorward to -40.1 degrees are summarized. Recurrent high-speed streams and corotating interaction regions dominated at middle latitudes. The speed of the solar wind was typically 700 to 800 kilometers per second poleward of -35 degrees . Corotating reverse shocks persisted farther south than did forward shocks because of the tilt of the heliomagnetic streamer belt. Sporadic coronal mass ejections were seen as far south as -60.5 degrees . Proton temperature was higher and the electron strahl was broader at higher latitudes. The high-latitude wind contained compressional, pressure-balanced, and Alfvénic structures.

Variation in hemodialysis patient compliance according to demographic characteristics.

Patient noncompliance with treatment regime undermines the effectiveness of medical care, resulting in an unpredictable progression of the primary disease and a greater likelihood of complications. Hemodialysis patients are well suited for studying noncompliance because their treatment is prolonged and intensive, and medical regimens are clear cut and easily determined with objective measures. Moreover, noncompliant behavior by these patients not only endangers their life in the long run, but also results in negative effects within a day or two. Despite severe consequences, noncompliance with their medical regimen is the norm for dialysis patients rather than the exception. A large-scale study of chronic, outpatient hemodialysis patients (N = 1230 patients, response rate = 96%) treated in a variety of facility types (N = 29 facilities) was conducted to investigate prevalence and associated demographic characteristics of noncompliance with four treatment regimens--protein and potassium restrictions in the diet, medication regimen, and fluid restrictions. Few patients were noncompliant with diet regimens (9% with protein and 2% with potassium restrictions) but half were noncompliant with medication taking (50.2%) and fluid restrictions (49.5%). The prevalence of noncompliance with medication and fluid regimens was consistent with previous studies of dialysis patients but the prevalence of noncompliance with diet was much lower than that reported elsewhere. Prevalence of noncompliant patients varied between studies according to the cut-point used to establish compliance criteria, where more stringent cut-points inflated the percentage and more lenient cut-points reduced the percentage. Thus, there is a need to establish uniform criteria in order to test real differences in compliance between patient groups vs simply differences in measurement.(ABSTRACT TRUNCATED AT 250 WORDS)

Organizational characteristics and administrative strategies associated with staff turnover.

In a study at 55 hemodialysis facilities, turnover was not associated with organizational size, location, or ownership but varied according to administrative strategies. Technician turnover (32 percent) was lower in facilities with shorter hours and choice of work schedule even though workload was higher. Clerical turnover (36 percent) was reduced with lower workloads. Nursing turnover (31 percent) was reduced in facilities in operation longer with shorter hours but equivalent workloads. Administrative turnover was negligible.

Jupiter's Magnetosphere: Plasma Description from the Ulysses Flyby.

Plasma observations at Jupiter show that the outer regions of the Jovian magnetosphere are remarkably similar to those of Earth. Bow-shock precursor electrons and ions were detected in the upstream solar wind, as at Earth. Plasma changes across the bow shock and properties of the magnetosheath electrons were much like those at Earth, indicating that similar processes are operating. A boundary layer populated by a varying mixture of solar wind and magnetospheric plasmas was found inside the magnetopause, again as at Earth. In the middle magnetosphere, large electron density excursions were detected with a 10-hour periodicity as planetary rotation carried the tilted plasma sheet past Ulysses. Deep in the magnetosphere, Ulysses crossed a region, tentatively described as magnetically connected to the Jovian polar cap on one end and to the interplanetary magnetic field on the other. In the inner magnetosphere and lo torus, where corotation plays a dominant role, measurements could not be made because of extreme background rates from penetrating radiation belt particles.

The impact of economic considerations on clinical decisionmaking: the case of thrombolytic therapy.

This study examines the intravenous use of two thrombolytic agents [streptokinase (SK) and tissue plasminogen activator (tPA)] in the acute phase of myocardial infarction (MI). These two agents have very different costs and offer an excellent opportunity to study both the impact of economic factors on clinical decisionmaking and the potential for cost savings by limiting the use of expensive new therapeutic agents. A nationwide survey of the 5,792 acute care general hospitals listed in the American Hospital Association's 1988 data file was responded to by 2,651 hospitals (46%) and revealed that 2,384 of these responding hospitals (90%) were using thrombolytic therapy. For 2,200 of these 2,384 hospitals (92%), the respondent was a physician who primarily used one of the two drugs. Eight hundred eighty-six of these 2,200 physicians (40%) primarily used SK while 1,314 (60%) primarily used tPA. SK users were more concentrated in federal public hospitals (69% used SK) than in nonfederal public hospitals (47% used SK), and were least concentrated in private hospitals (36% used SK). There was no difference between the rate of SK vs tPA use in investor-owned and not-for-profit private hospitals. SK users most often (62%) cited various economic factors as the reason for their choice. The users of tPA primarily (73%) cited clinical preferability as the reason for their choice even though trials are still ongoing to see which drug is preferable. Several multivariate analyses shed light upon the association between choice of thrombolytic agent and various additional physician and hospital characteristics. These data clearly indicate that while new therapies are rapidly implemented by the medical community, considerations of cost have a substantial impact upon the pattern of implementation and reflect a desire to implement cost savings in the use of new drugs.

Linear electric field mass analysis: a technique for three-dimensional high mass resolution space plasma composition measurements.

A revolutionary type of three-dimensional space plasma composition analyzer has been developed that combines very high-resolution mass composition measurements on a fraction of the incident ions simultaneously with lower mass resolution but high sensitivity measurements of the remaining population in a single compact and robust sensor design. Whereas the lower mass resolution measurements are achieved using conventional energy/charge (E/q) and linear time-of-flight analysis, the high mass resolution measurements are made by timing reflected E/q analyzed ions in a linear electric field (LEF). In a LEF the restoring (reflecting) force that an ion experiences in the direction parallel to the field is proportional to the depth it travels into the LEF region, and its equation of motion in that direction is that of a simple harmonic oscillator. Consequently, an ion's travel time is independent of its initial angle and energy and is simply proportional to the square root of the ion's mass/charge (m/q). The measured m/q resolution, (m/q)/Delta(m/q), for a small LEF-based prototype that we have developed and tested is approximately 20. In addition, our laboratory measurements with the prototype instrument show that characteristic time-of-flight spectra allow the resolution of atomic and molecular species with nearly identical m/q values. The measured response of the prototype is in excellent agreement with computer simulations of the device. Advanced design work using this computer simulation indicates that three-dimensional plasma composition analyzers with m/q resolutions of at least 50 are readily achievable.

Comet giacobini-zinner: plasma description.

A strong interaction between the solar wind and comet Giacobini-Zinner was observed oh 11 September 1985 with the Los Alamos plasma electron experiment on the International Cometary Explorer (ICE) spacecraft. As ICE approached an intercept point 7800 kilometers behind the nucleus from the south and receded to the north, upstream phenomena due to the comet were observed. Periods of enhanced electron heat flux from the comet as well as almost continuous electron density fluctuations were measured. These effects are related to the strong electron heating observed in the cometary interaction region and to cometary ion pickup by the solar wind, respectively. No evidence for a conventional bow shock was found as ICE entered and exited the regions of strongest interaction of the solar wind with the cometary environment. The outer extent of this strong interaction zone was a transition region in which the solar wind plasma was heated, compressed, and slowed. Inside the inner boundary of the transition region was a sheath that enclosed a cold intermediate coma. In the transition region and sheath, small-scale enhancements in density were observed. These density spikes may be due to an instability associated with cometary ion pickup or to the passage of ICE through cometary ray structures. In the center of the cold intermediate coma a narrow, high-density core of plasma, presumably the developing plasma tail was found. In some ways this tail can be compared to the plasma sheet in Earth's magnetotail and to the current sheet in the tail at Venus. This type of configuration is expected in the double-lobe magnetic topology detected at the comet, possibly caused by the theoretically expected draping of the interplanetary magnetic field around its ionosphere.

Effects of a long entrance aperture upon the azimuthal response of spherical section electrostatic analyzers.

The transmission characteristics of spherical section electrostatic analyzers with long entrance apertures have been studied. The presence of a long entrance aperture appreciably broadens the normally narrow azimuthal response of such analyzers at large incident polar angles. A technique for calculating the transmission at any polar angle is presented. Calculated azimuthal response curves at polar angles of 0 degrees , 25 degrees , and 50 degrees agree well with laboratory measurements for a 90 degrees section analyzer. In the limit of zero polar angle, our calculations reveal that a previously derived and widely used analytical expression for the integrated energy-angle response underestimates that response by 12%-25% depending upon the analyzer bending angle. An analytical expression that better approximates the true response is presented.

Observations at mercury encounter by the plasma science experiment on mariner 10.

A fully developed bow shock and magnetosheath were observed near Mercury, providing unambiguous evidence for a strong interaction between Mercury and the solar wind. Inside the sheath there is a distinct region analogous to the magnetosphere or magnetotail of Earth, populated by electrons with lower density and higher temperature than the electrons observed in the solar wind or magnetosheath. At the time of encounter, conditions were such that a perpendicular shock was observed on the inbound leg and a parallel shock was observed on the outbound leg of the trajectory, and energetic plasma electron events were detected upstream from the outbound shock crossing. The interaction is most likely not atmospheric, but the data clearly indicate that the obstacle to solar wind flow is magnetic, either intrinsic or induced. The particle fluxes and energy spectra showed large variations while the spacecraft was inside the magnetosphere, and these variations could be either spatial or temporal.

Observations at venus encounter by the plasma science experiment on mariner 10.

Preliminary results from the rearward-looking electrostatic analyzer of the plasma science experiment during the Mariner 10 encounter with Venus are described. They show that the solar-wind interaction with the planet probably involves a bow shock rather than an extended exosphere, but that this is not a thin boundary at the point where it was crossed by Mariner 10. An observed reduction in the flux of electrons with energies greater than 100 electron volts is interpreted as evidence for somne direct interaction with the exosphere. Unusual intermittent features observed downstream of the planet indicate the presence of a comet-like tail hundreds of scale lengths in length.