Factors associated with healthcare professionals' intent to stay in hospital: a comparison across five occupational categories.

OBJECTIVE: To identify factors associated with intent to stay in hospital among five different categories of healthcare professionals using an adapted version of the conceptual model of intent to stay (CMIS). DESIGN: A cross-sectional survey targeting Lausanne University Hospital employees performed in the fall of 2011. Multigroup structural equation modeling was used to test the adapted CMIS model among professional groups. Measures Satisfaction, self-fulfillment, workload, working conditions, burnout, overall job satisfaction, institutional identification and intent to stay. PARTICIPANTS: Surveys of 3364 respondents: 494 physicians, 1228 nurses, 509 laboratory technicians, 935 administrative staff and 198 psycho-social workers. RESULTS: For all professional categories, self-fulfillment increased intent to stay (all β > 0.14, P < 0.05). Burnout decreased intent to stay by weakening job satisfaction (β < -0.23 and β > 0.22, P < 0.05). Some factors were associated with specific professional categories: workload was associated with nurses' intent to stay (β = -0.15), and physicians' institutional identification mitigated the effect of burnout on intent to stay (β = -0.15 and β = 0.19). CONCLUSION: Respondents' intent to stay in a position depended both on global and profession-specific factors. The identification of these factors may help in mapping interventions and retention plans at both a hospital level and professional groups' level.

Logistic services as competitive means : segmenting the retail market for softwood lumber

Abstract

Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications

Objective: To determine the variation in prevalence of temporomandibular disorders (TMD), other side effects, and technical complications during 5 years of sleep apnea treatment with a mandibular advancement device. Materials and Methods: Forty patients diagnosed with obstructive sleep apnea received an adjustable appliance at 70% of the maximum protrusion. The protrusion was then progressively increased. TMD (diagnosed according to the Research Diagnostic Criteria for TMD), overjet, overbite, occlusal contacts, subjective side effects, and technical complications were recorded before and a mean of 14, 21, and 58 months after treatment and analyzed by the Wilcoxon test (P Less-than .05). Results: Fifteen patients still used the oral appliance at the 5-year follow-up, and no significant variation in TMD prevalence was observed. Subjective side effects were common, and a significant reduction was found in overjet, overbite, and in the number of occlusal contacts. Furthermore, the patients made a mean of 2.5 unscheduled dental visits per year and a mean of 0.8 appliance repairs/relines per year by a dental technician. The most frequent unscheduled visits were needed during the first year and were a result of acrylic breakage on the lateral telescopic attachment, poor retention, and other adjustments to improve comfort. Conclusions: Five-year oral appliance treatment does not affect TMD prevalence but is associated with permanent occlusal changes in most sleep apnea patients during the first 2 years. Patients seek several unscheduled visits, mainly because of technical complications.

Tolerance to flooding in five Brachiaria brizantha accessions

Some physiological and morphological responses of five Brachiaria brizantha accessions (BRA000591 cultivar Marandu, BRA003441, BRA002844, BRA004308 and BRA004391) were compared for plants grown in pots under flooding and well-drained conditions for 14 days. Flooding caused a significant reduction in leaf dry mass production in all accessions, but, for root biomass, no differences between treatments could be detected in BRA003441 and BRA004391. No adventitious root production was observed in flooded BRA003441; all other accessions produced adventitious roots when flooded. Relative growth rate was reduced by flooding only in BRA000591 and BRA004308. Leaf elongation rate was reduced by flooding in all accessions, however, more severely in BRA003441. Net photosynthesis was reduced by flooding in all accessions, but with less intensity in BRA004391. For all accessions, there was a close relationship between net photosynthesis and stomatal conductance under flooding. The five accessions tested differed in tolerance to flooding. BRA004391 was the most tolerant. Accession BRA003441 was the most sensitive, followed by BRA000591 cultivar Marandu. Accessions BRA002844 and BRA004308 were classified as intermediate in flooding tolerance.

Chronic low-frequency rTMS of primary motor cortex diminishes exercise training-induced gains in maximal voluntary force in humans.

Although there is consensus that the central nervous system mediates the increases in maximal voluntary force (maximal voluntary contraction, MVC) produced by resistance exercise, the involvement of the primary motor cortex (M1) in these processes remains controversial. We hypothesized that 1-Hz repetitive transcranial magnetic stimulation (rTMS) of M1 during resistance training would diminish strength gains. Forty subjects were divided equally into five groups. Subjects voluntarily (Vol) abducted the first dorsal interosseus (FDI) (5 bouts x 10 repetitions, 10 sessions, 4 wk) at 70-80% MVC. Another group also exercised but in the 1-min-long interbout rest intervals they received rTMS [Vol+rTMS, 1 Hz, FDI motor area, 300 pulses/session, 120% of the resting motor threshold (rMT)]. The third group also exercised and received sham rTMS (Vol+Sham). The fourth group received only rTMS (rTMS_only). The 37.5% and 33.3% gains in MVC in Vol and Vol+Sham groups, respectively, were greater (P = 0.001) than the 18.9% gain in Vol+rTMS, 1.9% in rTMS_only, and 2.6% in unexercised control subjects who received no stimulation. Acutely, within sessions 5 and 10, single-pulse TMS revealed that motor-evoked potential size and recruitment curve slopes were reduced in Vol+rTMS and rTMS_only groups and accumulated to chronic reductions by session 10. There were no changes in rMT, maximum compound action potential amplitude (M(max)), and peripherally evoked twitch forces in the trained FDI and the untrained abductor digiti minimi. Although contributions from spinal sources cannot be excluded, the data suggest that M1 may play a role in mediating neural adaptations to strength training.

Combined report on the institutions under the control of the Iowa Department of Human Services for the five years ended June 30, 2013

Combined report on the institutions under the control of the Iowa Department of Human Services for the five years ended June 30, 2013

Combined report on the institutions under the control of the Iowa Department of Corrections for the five years ended June 30, 2013

Combined report on the institutions under the control of the Iowa Department of Corrections for the five years ended June 30, 2013

Testing the competitive exclusion principle using various niche parameters in a native (Natrix maura) and an introduced (N. tessellata) colubrid

Despite the increase of animal and plant introductions worldwide and the strong augmentation of the reptile trade, few invasive snake populations have been studied. Dice snakes (Natrix tessellata) were introduced to the shores of Lake Geneva (Switzerland) in the early 1920s, and are now well established. This region of introduction was previously inhabited by Viperine snakes (N. maura). Ever since these two species have been under monitoring (which began in 1996) the Viperine snake population has shown drastic decline. We examine here the possibility of trophic competition by analysing diet composition, prey size and trophic niche overlap. Spatial distribution is also assessed in order to address the question of spatial competitive exclusion. We found very similar diets, and thus a high trophic niche overlap, indicating no partitioning of the trophic resource. No arguments in favour of spatial competitive exclusion were found. Our study suggests that trophic competition may occur between the two natricines and that it may give an explanation for the drastic decline of the Viperine snake in this area. Other pathways potentially playing a role in the exclusion of the Viperine snake are discussed.

Roux-en-y Gastric Bypass is Superior to Gastric Banding in Non-superobese Patients. a Matched-case Study with Five-year Follow-up

Background: Roux-en-Y gastric bypass (RYGBP) and gastric banding (GB) are the two most popular bariatric procedures. Only few studies have compared their results and follow-up duration is usually limited to <3 years. Patients and Methods: Using our prospective bariatric database, we matched non-superobese GB to RYGBP patients for sex, age and BMI to RYGBP. Follow-up considered up to five years. Results: 442 patients were matched in 221 pairs. Mean age (38,6) and mean BMI (43) were identical. Overall operative morbidity was higher after RYGBP (17,2 versus 5,4 %, p<0,001), but major morbidity was similar (3,6 versus 2,2 %, p=0,57). More patients developed long-term complications after GB (43,9 % versus 19 %, p<0,001), and more required reoperations (24,4 % versus 12 %, p=0,001). After RYGBP, reoperations were mainly due to internal hernias (87 %), with no reversal, whereas 18,5 % of the GB patients required band removal. Even including only patients who retained their band, weight loss after RYGBP was better throughout the study period, with 5-year EBMIL of 77,6 % and 61,7 % (p<0,001) after RYGBP and GB respectively. RYGBP was associated with better food tolerance and greater improvement of the lipid profile. Conclusions: GB is associated with a smaller overall operative morbidity and similar major morbidity, but with more long-term complications, more reoperations, a significant number of reversal or conversion procedures, and reduced weight loss when compared with RYGBP. Five-year results of RYGBP are superior to GB and patients should be informed accordingly.