Burnout in medical students: A systematic review of experiences in Chinese medical schools

© 2017 The Author(s). Background: To identify the: extent to which medical students in China experience burnout; factors contributing to this; potential solutions to reduce and prevent burnout in this group; and the extent to which the experiences of Chinese students reflect the international literature. Methods: Systematic review and narrative synthesis. Key words, synonyms and subject headings were used to search five electronic databases in addition to manual searching of relevant journals. Titles and abstracts of publications between 1st January 1989-31st July 2016 were screened by two reviewers and checked by a third. Full text articles were screened against the eligibility criteria. Data on design, methods and key findings were extracted and synthesised. Results: Thirty-three studies were eligible and included in the review. Greater levels of burnout were generally identified in males, more senior medical students, and those who already experienced poorer psychological functioning. Few studies explored social or contextual factors influencing burnout, but those that did suggest that factors such as the degree of social support or the living environment surrounding a student may be a determinant of burnout. Conclusions: Greater understanding of the social and contextual determinants of burnout amongst medical students in China is essential towards identifying solutions to reduce and prevent burnout in this group

Vegetation composition and soil microbial community structural changes along a wetland hydrological gradient

Fluctuations in wetland hydrology create an interplay between aerobic and anaerobic conditions, controlling vegetation composition and microbial community structure and activity in wetland soils. In this study, we investigated the vegetation composition and microbial community structural and functional changes along a wetland hydrological gradient. Two different vegetation communities were distinguished along the hydrological gradient; <i>Caricetum gracilis</i> at the wet depression and <i>Arrhenatheretum elatioris</i> at the drier upper site. Microbial community structural changes were studied by a combined in situ <sup>13</sup>CO<sub>2</sub> pulse labeling and phospholipid fatty acid (PLFA) based stable isotope probing approach, which identifies the microbial groups actively involved in assimilation of newly photosynthesized, root-derived C in the rhizosphere soils. Gram negative bacterial communities were relatively more abundant in the surface soils of the drier upper site than in the surface soils of the wetter lower site, while the lower site and the deeper soil layers were relatively more inhabited by gram positive bacterial communities. Despite their large abundance, the metabolically active proportion of gram positive bacterial and actinomycetes communities was much smaller at both sites, compared to that of the gram negative bacterial and fungal communities. This suggests much slower assimilation of root-derived C by gram positive and actinomycetes communities than by gram negative bacteria and fungi at both sites. Ground water depth showed a significant effect on the relative abundance of several microbial communities. Relative abundance of gram negative bacteria significantly decreased with increasing ground water depth while the relative abundance of gram positive bacteria and actinomycetes at the surface layer increased with increasing ground water depth

A new chemical method for purification and surface modification of Sri Lankan vien graphite

Sri Lanka has its own demarcated possession for the high quality vein graphite containing 95-98 % of initial purity of carbon.Presently Sri Lankan vein graphite is exported as a cheap raw material without any value addition. The present study focuses to find a cost effective and convenient new chemical method for the graphite purification and to modify the graphite surface using alkali chloride solutions for improving performance of a graphite electrode (for negative electrode) of batteries. Collected vein graphite samples were powdered and prepared samples (10 g of <53 μm) were treated for acid digestion method with a mixture of 5 % of HF, Con.H2SO4& Con.HNO3. 3.50 g of portions graphite powders were separately mixed with 100 ml of 0.1% LiCl, 0.1% KCl and 0.1 % NaCl aqueous solutions for preparing of surface modified graphite. The carbon content of the Needle Platy Graphite (NPG) variety has the highest carbon content and the purity of the samples has been enhanced after acid digestion treatment by removing impurities. The FTIR analysis proved that many of impurity related functional group bands have been removed from the surface modified NPG.The Lithium, Sodium and Potassium Chloride coatings were capable to improve the electric conductivity performance

How do stroke survivors and their carers use practitioners' advice on secondary prevention medications? Qualitative study of an online forum

$\textbf{Background}$: Secondary prevention medications reduce risk of stroke recurrence, yet many people do not receive recommended treatment, nor take medications optimally. $\textbf{Objective}$: Exploring how patients report making use of practitioners' advice on secondary prevention medicines on an online forum and what feedback was received from other participants. $\textbf{Methods}$: Thematic analysis of the archive of Talkstroke (2004-2011), UK. Posts including any secondary prevention medication terms, General Practitioner (GP) and their replies were identified. $\textbf{Results}$: Fifity participants talked about practitioners' advice on secondary prevention medications in 43 discussion threads. Patients consulted practitioners for reassurance and dealing with side effects. Practitioners' advice varied from altering to maintaining current treatment. Three main themes emerged from the use of practitioners' advice: patients following advice (reassured, happy when side effects made tolerable, or still retaining anxiety about treatment); patients not following advice (admitting adherence on-off or stopping medications as side effects still not tolerable); asking other participants for feedback on advice received. Practitioners' advice was disregarded mainly when related to dealing with statin side effects, after one or two consultations. Themes for feedback involved sharing experience, directing back to practitioners, or to external evidence. $\textbf{Conclusions}$: Side effects of secondary prevention medications and statins in particular, cause anxiety and resentment in some patients, and their concerns are not always addressed by practitioners. Practitioners could consider more proactive strategies to manage such side effects. Forum feedback was appropriate and supportive of the practitioners' advice received. Our findings from peer-to-peer online conversations confirm and widen previous research.Anna De Simoni is funded by a NIHR Academic Clinical Lectureship

Understanding the ongoing learning needs of Australian metropolitan, rural and remote paediatricians: Evaluation of a neurology outreach programme

Aim: The purpose of this study was to evaluate whether a neurology outreach teaching programme delivered via video-teleconferencing (6 × 60 min live sessions every 6–8 weeks) is acceptable, contributes to understanding and meets the neurology learning needs of Australian paediatricians from metropolitan, rural and remote areas. Methods: A sample of six NSW sites that joined the neurology outreach programme between 2017 and 2019 (Arm 1) and six interstate sites from QLD, WA and TAS who commenced the programme in 2020 (Arm 2) participated. A mixed-methods survey explored participants' learning needs and value of the programme. Results: Forty-six participants submitted programme evaluation surveys (26 arm 1, 20 arm 2); 9 were removed due to insufficient data (n = 37). Quantitative and qualitative data showed the programme was acceptable in format, relevant to practice, appropriate for clinician learning needs, and engaging. Clinicians reported improvement in understanding and confidence. Participants felt more connected/less isolated and up-to-date. Participants reported a positive impact from the programme on approach to neurological problems and ensuing consults, and more differentiated and appropriate paediatric neurology referrals. Conclusion: This study validates the live video-teleconference outreach model as an acceptable, effective and important means of providing continuing neurology education for Australian paediatricians

Effect of free range poultry system on land use efficiency and floral diversity in Rubber plantations

Plantation crops like rubber were traditionally grown in monocultures to avoid any risk on theirproductivity. However, with the smallholder farmers being involved in rubber cultivation, the idea offarming system evolved with the maximizing the overall land productivity and diversifying the incomesources in order to meet the need ofthe resource poor. At present, rubber based intercropping systemswith other economically beneficial crops are recommended and being practised to some extentparticularly in smallholdings. However, no successful attempts were taken on livestock integration tothe rubber system. With the understanding of practical limitations in incorporating ruminants to thesystem, the present study was commenced as a preliminary investigation to assess the effectivenessof free range poultry with respect to productivity and its effects on floral diversity under rubber.Based on the experience in coconut based poultry systems in Sri Lanka, a strain developed as abackcross of the hybrid between CPRS (Central Poultry Research Station) Brown and indigenouswith indigenous, was used in this study expecting desired characteristics of both types. i.e., high levelof egg production and adaptability to the environment. The trial began with 30 birds in a mature rubberclearing of the Rubber Research Institute of Sri Lanka. Information on egg production, the effectpoultry on weed growth and its diversity were recorded together with visual observations on birds'behavior.Average egg production was 8 eggs per bird per month. This value has dropped to 3 when themajority of birds were in moulting, However, in some months, it has gone up to 14. Some birds wereki lied by predators and even unsuccessful attacks affected the egg production. Birds showed poorbrooding characters with that attempts taken to hatch eggs were failed. Poultry feeds had to besupplied (SOg layer ration per bird) to maintain the continuous egg production. Birds always used tofeed on the area close human dwelling. Dominance of the floral species under rubber was changedwith the incorporation of poultry. Although Adiantum latifolium was dominant throughout the study.Summed Dominance Ratio (SDR) of Paspalam conjugatum and Syngonium podophyllum declinedwith the poultry integration. Measures to be taken to improve the poultry system were also identified.

Ethnic differences in cancer symptom awareness and barriers to seeking medical help in England

Background: Ethnic differences in cancer symptom awareness and barriers to seeking medical help in the English population are not fully understood. We aimed to quantify these differences, to help develop more effective health campaigns, tailored to the needs of different ethnic groups. Methods: Using a large national data set (n=38492) of cross-sectional surveys that used the Cancer Research UK Cancer Awareness Measure, we examined how cancer symptom awareness and barriers varied by ethnicity, controlling for socio-economic position, age and gender. Data were analysed using multivariable logistic regression. Results: Awareness of cancer symptoms was lower in minority ethnic groups than White participants, with the lowest awareness observed among Bangladeshis and Black Africans. Ethnic minorities were more likely than White British to report barriers to helpseeking. South Asians reported the highest emotional barriers, such as lack of confidence to talk to the doctor, and practical barriers, such as worry about many other things. The Irish were more likely than the White British to report practical barriers, such as being too busy to visit a doctor. White British participants were more likely than any other ethnic group to report that they would feel worried about wasting the doctor’s time. Overall, Black Africans had the lowest barriers. All differences were statistically significant (P<0.01 level), after controlling for confounders. Conclusions: Our findings suggest the need for culturally sensitive and targeted health campaigns, focused on improving recognition of cancer symptoms among ethnic minorities. Campaigns should tackle the specific barriers prevalent in each ethnic group