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A survey of resilience, burnout, and tolerance of uncertainty in Australian general practice registrars
Cooke Georga PE,Doust Jenny A,Steele Michael C
BMC Medical Education , 2013, DOI: 10.1186/1472-6920-13-2
Abstract: Background Burnout and intolerance of uncertainty have been linked to low job satisfaction and lower quality patient care. While resilience is related to these concepts, no study has examined these three concepts in a cohort of doctors. The objective of this study was to measure resilience, burnout, compassion satisfaction, personal meaning in patient care and intolerance of uncertainty in Australian general practice (GP) registrars. Methods We conducted a paper-based cross-sectional survey of GP registrars in Australia from June to July 2010, recruited from a newsletter item or registrar education events. Survey measures included the Resilience Scale-14, a single-item scale for burnout, Professional Quality of Life (ProQOL) scale, Personal Meaning in Patient Care scale, Intolerance of Uncertainty-12 scale, and Physician Response to Uncertainty scale. Results 128 GP registrars responded (response rate 90%). Fourteen percent of registrars were found to be at risk of burnout using the single-item scale for burnout, but none met the criteria for burnout using the ProQOL scale. Secondary traumatic stress, general intolerance of uncertainty, anxiety due to clinical uncertainty and reluctance to disclose uncertainty to patients were associated with being at higher risk of burnout, but sex, age, practice location, training duration, years since graduation, and reluctance to disclose uncertainty to physicians were not. Only ten percent of registrars had high resilience scores. Resilience was positively associated with compassion satisfaction and personal meaning in patient care. Resilience was negatively associated with burnout, secondary traumatic stress, inhibitory anxiety, general intolerance to uncertainty, concern about bad outcomes and reluctance to disclose uncertainty to patients. Conclusions GP registrars in this survey showed a lower level of burnout than in other recent surveys of the broader junior doctor population in both Australia and overseas. Resilience was also lower than might be expected of a satisfied and professionally successful cohort.
Information from Pharmaceutical Companies and the Quality, Quantity, and Cost of Physicians' Prescribing: A Systematic Review
Geoffrey K. Spurling ,Peter R. Mansfield,Brett D. Montgomery,Joel Lexchin,Jenny Doust,Noordin Othman,Agnes I. Vitry
PLOS Medicine , 2010, DOI: 10.1371/journal.pmed.1000352
Abstract: Background Pharmaceutical companies spent $57.5 billion on pharmaceutical promotion in the United States in 2004. The industry claims that promotion provides scientific and educational information to physicians. While some evidence indicates that promotion may adversely influence prescribing, physicians hold a wide range of views about pharmaceutical promotion. The objective of this review is to examine the relationship between exposure to information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing. Methods and Findings We searched for studies of physicians with prescribing rights who were exposed to information from pharmaceutical companies (promotional or otherwise). Exposures included pharmaceutical sales representative visits, journal advertisements, attendance at pharmaceutical sponsored meetings, mailed information, prescribing software, and participation in sponsored clinical trials. The outcomes measured were quality, quantity, and cost of physicians' prescribing. We searched Medline (1966 to February 2008), International Pharmaceutical Abstracts (1970 to February 2008), Embase (1997 to February 2008), Current Contents (2001 to 2008), and Central (The Cochrane Library Issue 3, 2007) using the search terms developed with an expert librarian. Additionally, we reviewed reference lists and contacted experts and pharmaceutical companies for information. Randomized and observational studies evaluating information from pharmaceutical companies and measures of physicians' prescribing were independently appraised for methodological quality by two authors. Studies were excluded where insufficient study information precluded appraisal. The full text of 255 articles was retrieved from electronic databases (7,185 studies) and other sources (138 studies). Articles were then excluded because they did not fulfil inclusion criteria (179) or quality appraisal criteria (18), leaving 58 included studies with 87 distinct analyses. Data were extracted independently by two authors and a narrative synthesis performed following the MOOSE guidelines. Of the set of studies examining prescribing quality outcomes, five found associations between exposure to pharmaceutical company information and lower quality prescribing, four did not detect an association, and one found associations with lower and higher quality prescribing. 38 included studies found associations between exposure and higher frequency of prescribing and 13 did not detect an association. Five included studies found evidence for association with higher costs, four
Expanding Disease Definitions in Guidelines and Expert Panel Ties to Industry: A Cross-sectional Study of Common Conditions in the United States
Raymond N. Moynihan ,Georga P. E. Cooke,Jenny A. Doust,Lisa Bero,Suzanne Hill,Paul P. Glasziou
PLOS Medicine , 2013, DOI: 10.1371/journal.pmed.1001500
Abstract: Background Financial ties between health professionals and industry may unduly influence professional judgments and some researchers have suggested that widening disease definitions may be one driver of over-diagnosis, bringing potentially unnecessary labeling and harm. We aimed to identify guidelines in which disease definitions were changed, to assess whether any proposed changes would increase the numbers of individuals considered to have the disease, whether potential harms of expanding disease definitions were investigated, and the extent of members' industry ties. Methods and Findings We undertook a cross-sectional study of the most recent publication between 2000 and 2013 from national and international guideline panels making decisions about definitions or diagnostic criteria for common conditions in the United States. We assessed whether proposed changes widened or narrowed disease definitions, rationales offered, mention of potential harms of those changes, and the nature and extent of disclosed ties between members and pharmaceutical or device companies. Of 16 publications on 14 common conditions, ten proposed changes widening and one narrowing definitions. For five, impact was unclear. Widening fell into three categories: creating “pre-disease”; lowering diagnostic thresholds; and proposing earlier or different diagnostic methods. Rationales included standardising diagnostic criteria and new evidence about risks for people previously considered to not have the disease. No publication included rigorous assessment of potential harms of proposed changes. Among 14 panels with disclosures, the average proportion of members with industry ties was 75%. Twelve were chaired by people with ties. For members with ties, the median number of companies to which they had ties was seven. Companies with ties to the highest proportions of members were active in the relevant therapeutic area. Limitations arise from reliance on only disclosed ties, and exclusion of conditions too broad to enable analysis of single panel publications. Conclusions For the common conditions studied, a majority of panels proposed changes to disease definitions that increased the number of individuals considered to have the disease, none reported rigorous assessment of potential harms of that widening, and most had a majority of members disclosing financial ties to pharmaceutical companies. Please see later in the article for the Editors' Summary
Synthesis of Poly(AAm-co-AA) and Investigation of its Swelling Behavior: Using Response Surface Methodology (RSM)  [PDF]
Samira Heidari, Jafar Saberi Doust, Feridun Esmaeilzadeh
Modeling and Numerical Simulation of Material Science (MNSMS) , 2018, DOI: 10.4236/mnsms.2018.84004
Abstract: Unwanted water production together with oil and gas production is a striking problem in oil and gas industries, and many approaches have been examined to overcome this major problem. Preformed particle gels (PPGs) showed dramatically good properties for this purpose in mature oil and gas reservoirs. In this study, we carefully synthesized an efficient series of PPGs with using a design of experiments (DOE) software. Acrylamide (AAm)/Acrylic acid (AA) mole ratio, N,N’-methylenebisacrylamide (MBA) mole percentage and swelling time were considered as key parameters to examine PPG swelling behavior. Our results presented a detailed empirical correlation, which could significantly predict the swelling capacity of PPGs in CaCl2 salt solution (200,000 ppm).
Enhanced negative type for finite metric trees
Ian Doust,Anthony Weston
Mathematics , 2007, DOI: 10.1016/j.jfa.2008.01.013
Abstract: Finite metric trees are known to have strict 1-negative type. In this paper we introduce a new family of inequalities that quantify the extent of the "strictness" of the 1-negative type inequalities for finite metric trees. These inequalities of "enhanced 1-negative type" are sufficiently strong to imply that any given finite metric tree must have strict p-negative type for all values of p in an open interval that contains the number 1. Moreover, these open intervals can be characterized purely in terms of the unordered distribution of edge weights that determine the path metric on the particular tree, and are therefore largely independent of the tree's internal geometry. From these calculations we are able to extract a new non linear technique for improving lower bounds on the maximal p-negative type of certain finite metric spaces. Some pathological examples are also considered in order to stress certain technical points.
Functional calculus on Venturi for Groups with Finite Propagation Speed
Gordon Blower,Ian Doust
Mathematics , 2013,
Abstract: Let ${\cal{M}}$ be a complete Riemannian manifold with Ricci curvature bounded below and Laplace operator $\Delta$. The paper develops a functional calculus for the cosine family $\cos(t\sqrt {\Delta})$ which is associated with waves that travel at unit speed. If $f$ is holomorphic on a Venturi shaped region, and $z^kf(z)$ is bounded for some positive integer $k$, then $f({\sqrt \Delta})$ defines a bounded linear operator on $L^p({\cal{M}})$ for some $p>2$. For Jacobi hypergroups with invariant measure $m$ the generalized Fourier transform of $f\in L^1(m)$ gives $\hat f\in H^\infty (\Sigma_\omega)$ for some strip $\Sigma_\omega$. Hence one defines $\hat f(A)$ for operators $A$ in some Banach space that have a $H^\infty (\Sigma_\omega)$ functional calculus. The paper introduces an operational calculus for the Mehler--Fock transform of order zero. By transference methods, one defines $\hat f(A)$ when $\hat f$ is a $s$-Marcinkiewicz multiplier and $e^{itA}$ is a strongly continuous operator group on a $L^p$ space for $| 1/2-1/p| <1/s$.\par
Approximation in $AC(σ)$
Ian Doust,Michael Leinert
Mathematics , 2013,
Abstract: In order to extend the theory of well-bounded operators to include operators with nonreal spectrum, Ashton and Doust introduced definitions for two new algebras of functions defined on a nonempty compact subset $\sigma$ of the plane. These are the functions of bounded variation and the absolutely continuous functions on $\sigma$. Proofs involving absolutely continuous functions usually require that one first works with elements of a dense subset and then take limits. In this paper we present some new theorems about approximating absolutely continuous functions as well as providing missing proofs for some important earlier results.
Isomorphisms of $AC(σ)$ spaces
Ian Doust,Michael Leinert
Mathematics , 2013,
Abstract: Analogues of the classical Banach-Stone theorem for spaces of continuous functions are studied in the context of the spaces of absolutely continuous functions introduced by Ashton and Doust. We show that if $AC(\sigma_1)$ is algebra isomorphic to $AC(\sigma_2)$ then $\sigma_1$ is homeomorphic to $\sigma_2$. The converse however is false. In a positive direction we show that the converse implication does hold if the sets $\sigma_1$ and $\sigma_2$ are confined to a restricted collection of compact sets, such as the set of all simple polygons.
Operational calculus and integral transforms for groups with finite propagation speed
Gordon Blower,Ian Doust
Mathematics , 2015,
Abstract: Let $A$ be the generator of a strongly continuous cosine family $(\cos (tA))_{t\in {\bf R}}$ on a complex Banach space $E$. The paper develops an operational calculus for integral transforms and functions of $A$. Characters of hypergroups which have Laplace representations give rise to bounded operators on $E$. Examples include the Mellin transform and the Mehler--Fock transform. The primary example concerns the Laplace operator $\Delta$ on a complete Riemannian manifold ${\cal{M}}$ with Ricci curvature bounded below. The results then apply to $A=\sqrt{\Delta}$ in $E=L^p({\cal{M}} )$ for some $2\leq p<\infty$. The paper uses functional calculus for the cosine family $\cos( t\sqrt {\Delta})$ which is associated with waves that travel at unit speed.
Extensions of an $AC(σ)$ functional calculus
Ian Doust,Venta Terauds
Mathematics , 2008, DOI: 10.1016/j.jmaa.2009.10.001
Abstract: On a reflexive Banach space $X$, if an operator $T$ admits a functional calculus for the absolutely continuous functions on its spectrum $\sigma(T) \subseteq \mathbb{R}$, then this functional calculus can always be extended to include all the functions of bounded variation. This need no longer be true on nonreflexive spaces. In this paper, it is shown that on most classical separable nonreflexive spaces, one can construct an example where such an extension is impossible. Sufficient conditions are also given which ensure that an extension of an $\AC$ functional calculus is possible for operators acting on families of interpolation spaces such as the $L^p$ spaces.
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