National survey of job satisfaction and retirement intentions among general practitioners in England

Objectives To measure general practitioners' intentions to quit direct patient care, to assess changes between 1998 and 2000, and to investigate associated factors, notably job satisfaction. Design Analysis of national postal surveys conducted in 1998 and 2001. Setting England. Participants 1949 general practitioner principals, of whom 790 were surveyed in 1998 and 1159 in 2001. Main outcome measures Overall job satisfaction and likelihood of leaving direct patient care in the next five years. Results The proportion of doctors intending to quit direct patient care in the next five years rose from 14% in 1998 to 22% in 2001. In both years, the main factors associated with an increased likelihood of quitting were older age and ethnic minority status. Higher job satisfaction and having children younger than 18 years were associated with a reduced likelihood of quitting. There were no significant differences in regression coefficients between 1998 and 2001, suggesting that the effect of factors influencing intentions to quit remained stable over time. The rise in intentions to quit was due mainly to a reduction in job satisfaction (1998 mean 4.64, 2001 mean 3.96) together with a slight increase in the proportion of doctors from ethnic minorities and in the mean age of doctors. Doctors' personal and practice characteristics explained little of the variation in job satisfaction within or between years. Conclusions Job satisfaction is an important factor underlying intention to quit, and attention to this aspect of doctors' working lives may help to increase the supply of general practitioners

Search dog handlers show positive bias when scoring their own dog's performance

Self-assessments of performance are commonly used in the human workplace, although compared to peer or supervisor ratings, they may be subject to positive biases or leniency. The use of subjective ratings scales in animal sciences is also common, although little consideration is usually given to possible rater bias. Dog handlers, work very closely and form strong relationships with their dogs and are also best placed to monitor dog performance since they often work in isolation. Previous work found ratings of search dog performance correlated well between experienced dog trainers, instructors, and scientists; but until now, there has been no investigation into ratings made by a dog's own handler. We compared handlers' subjective assessment of their own dog's search performance to scores given by other handlers and in a second study, to scores made by impartial raters. We found that handlers generally showed leniency; for example scoring their own dogs more favorably for Control (responsiveness to commands) and Strength of Indication. But the degree of bias varied with the trait being scored and between raters. Such differences may be attributable to greater desirability or importance of favorable scores for certain traits, or a lack of clarity of their precise meaning. Handlers may vary in susceptibility to bias due to differing levels of experience and the extent to which they view their dog's ability as dependent on their own. The exact causes require further investigation. We suggest working dog agencies provide rater-training to overcome leniency, improve reliability and validity, and to increase handler's motivation to provide accurate assessments. This study represents one of a series of steps to formulate robust, validated and evidence-based performance rating systems and has relevance to any situation where raters assess their own performance or others (particularly where they may have a vested interest in, or loyalty toward, the ratee)

Trees for Shelter: The Implications in Agroforestry System

The objective of this study was to determine the horizontal and vertical variations in soil penetration resistance (PR) observed at tree-scale in silvopastoral plots that were grazed by sheep with and without trees. Sycamore trees (Acer pseudoplatanus L) were planted in the spring of 1988 at 10 m x 10 m spacing (100 stems/ha) at Glensaugh NE of Scotland on plots replicated over three blocks in Randomized Complete Block design on a predominantly rye grass (Lolium perenne L) pasture. Included in the design were pasture plots without trees (Control). The experiment is grazed by sheep yearly from April to October. Soil PR was measured in Mega Pascals (MPa) around two randomly selected trees in each plot in 8 directions of the compass - N, NE, E, SE, S, SW, W and NW at 1 m intervals starting at 0.5 m from the tree base to mid point of the separation distance (4.5 m) between the trees. The soil PR data were measured at 3.5 cm soil depth intervals at points around the tree up to depth limit of 21.0 cm. This gave six depth intervals of d1 (3.5), d2 (7.0), d3 (10.5), d4 (14.0), d5 (17.5) and d6 (21.0). In the Control plots, soil PR was measured as in the Sycamore plots around two hypothetical tree positions chosen randomly in each plot. The soil PR was found to decrease significantly within the horizontal distance of 4.5 m from the tree and depth for up to d3 (10.5 cm) only in the grazed Sycamore plots. Soil penetrometer resistance was found to increase significantly within the vertical distance of 0-14 cm of the soil around the tree in grazed Sycamore and Control plots. Beyond this soil depth, soil PR was no longer significant in these treatments

Soil Nutrient Redistribution Pattern About the Tree in a Silvopastoral System

The objective of this paper is to report the effect of animal-tree interactions on soil nutrient redistribution pattern in a grazed silvopastoral experiment site at Glensaugh, in NE Scotland. Scots pine (Pinus sylvestris L) tree species were planted in square lattice arrangements at 5 m x 5 m, spacing (400 stems/ha) on plots replicated over three blocks in Randomized Complete Block design on a predominantly rye grass (Lolium perenne L) pasture which was grazed by sheep yearly from April to October. Included in the design were grazed pasture plots without trees (Control). Soil samples were collected from around two randomly selected trees in each plot in four directions N, E, S and W at 1 m interval starting at 0.5 m from the tree base up to mid point of the separation distance between trees. In the Control plots, soil samples were collected as above from two hypothetical tree positions chosen randomly. The analysis of variance result showed that soil total N, %C and Organic matter (OM) increased significantly with horizontal distance from the tree in the grazed Scots pine plots whereas soil nutrients did not vary significantly with horizontal distance from the tree in the Control plots

Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis

Abstract Introduction Intensive care unit (ICU) admission for bone marrow transplant recipients immediately following transplantation is an ominous event, yet the survival of these patients with subsequent ICU admissions is unknown. Our objective was to determine the long-term outcome of bone marrow transplant recipients admitted to an ICU during subsequent hospitalizations. Methods We conducted a population-based cohort analysis of all adult bone marrow transplant recipients who received subsequent ICU care in Ontario, Canada from 1 January 1992 to 31 March 2002. The primary endpoint was mortality at 1 year. Results A total of 2,653 patients received bone marrow transplantation; 504 of which received ICU care during a subsequent hospitalization. Patients receiving any major procedure during their ICU stay had higher 1-year mortality than those patients who received no ICU procedure (87% versus 44%, P < 0.0001). Death rates at 1 year were highest for those receiving mechanical ventilation (87%), pulmonary artery catheterization (91%), or hemodialysis (94%). In combination, the strongest independent predictors of death at 1 year were mechanical ventilation (odds ratio, 7.4; 95% confidence interval, 4.8 to 11.4) and hemodialysis (odds ratio, 8.7; 95% confidence interval, 2.1 to 36.7), yet no combination of procedures uniformly predicted 100% mortality. Conclusion The prognosis of bone marrow transplant recipients receiving ICU care during subsequent hospitalizations is very poor but should not be considered futile

The public health response to ‘do-it-yourself’ urbanism

Greater understanding of the important and complex relationship between the built environment and human health has made ‘healthy places’ a focus of public health and health promotion. While current literature concentrates on creating healthy places through traditional decision-making pathways (namely, municipal land use planning and urban design processes), this paper explores do-ityourself (DIY) urbanism: a movement circumventing traditional pathways to, arguably, create healthy places and advance social justice. Despite being aligned with several health promotion goals, DIY urbanism interventions are typically illegal and have been categorized as a type of civil disobedience. This is challenging for public health officials who may value DIY urbanism outcomes, but do not necessarily support the means by which it is achieved. Based on the literature, we present a preliminary approach to health promotion decision-making in this area. Public health officials can voice support for DIY urbanism interventions in some instances, but should proceed cautiously

Factors Impacting Primary Care Engagement in a New Approach to Integrating Care in Ontario, Canada.

INTRODUCTION: In 2019, Ontario\u27s Ministry of Health (the Ministry) introduced Ontario Health Teams (OHTs) to provide population-based integrated healthcare. Primary care was foundational to this approach. We sought to identify factors that impacted primary care engagement during OHT formation from different perspectives. METHODS: Interviews with 111 participants (administrators n = 80; primary care providers n = 17; patient family advisors = 14) from 11 OHTs were conducted following a semi-structured guide. Interviews were transcribed, coded, and thematically analyzed. RESULTS: Participants felt that primary care engagement was an ongoing, continuous cycle. Four themes were identified: 1) \u27A low rules environment\u27: limited direction from the Ministry (system-level), 2) \u27They\u27re at different starting points\u27: impact of local context (initiative-level); 3) \u27We want primary care to be actively involved\u27: engagement efforts made by OHTs (initiative-level); 4) \u27Waiting to hear a little bit more\u27: primary care concerns about the OHT approach (sector-level). Thirteen factors impacting primary care engagement were identified across the four themes. DISCUSSION AND CONCLUSION: The 13 factors influencing primary care engagement were interconnected and operated at health system, integrated care initiative, and sector levels. Future research should focus on integrated care initiatives as they mature, to address potential gaps in the involvement of primary care physicians

Managing healthcare budgets in times of austerity: the role of program budgeting and marginal analysis

Given limited resources, priority setting or choice making will remain a reality at all levels of publicly funded healthcare across countries for many years to come. The pressures may well be even more acute as the impact of the economic crisis of 2008 continues to play out but, even as economies begin to turn around, resources within healthcare will be limited, thus some form of rationing will be required. Over the last few decades, research on healthcare priority setting has focused on methods of implementation as well as on the development of approaches related to fairness and legitimacy and on more technical aspects of decision making including the use of multi-criteria decision analysis. Recently, research has led to better understanding of evaluating priority setting activity including defining ‘success’ and articulating key elements for high performance. This body of research, however, often goes untapped by those charged with making challenging decisions and as such, in line with prevailing public sector incentives, decisions are often reliant on historical allocation patterns and/or political negotiation. These archaic and ineffective approaches not only lead to poor decisions in terms of value for money but further do not reflect basic ethical conditions that can lead to fairness in the decision-making process. The purpose of this paper is to outline a comprehensive approach to priority setting and resource allocation that has been used in different contexts across countries. This will provide decision makers with a single point of access for a basic understanding of relevant tools when faced with having to make difficult decisions about what healthcare services to fund and what not to fund. The paper also addresses several key issues related to priority setting including how health technology assessments can be used, how performance can be improved at a practical level, and what ongoing resource management practice should look like. In terms of future research, one of the most important areas of priority setting that needs further attention is how best to engage public members