A comparison of course-related stressors in undergraduate problem-based learning (PBL) versus non-PBL medical programmes

Background: Medical students report high levels of stress related to their medical training as well as to other personal and financial factors. The aim of this study is to investigate whether there are differences in course-related stressors reported by medical students on undergraduate problem-based learning (PBL) and non-PBL programmes in the UK. Method: A cross-sectional study of second-year medical students in two UK medical schools (one PBL and one non-PBL programme) was conducted. A 16-question self-report questionnaire, derived from the Perceived Medical Student Stress Scale and the Higher Education Stress Inventory, was used to measure course-related stressors. Following univariate analysis of each stressor between groups, multivariate logistic regression was used to determine which stressors were the best predictors of each course type, while controlling for socio-demographic differences between the groups. Results: A total of 280 students responded. Compared to the non-PBL students (N = 197), the PBL students (N = 83) were significantly more likely to agree that: they did not know what the faculty expected of them (Odds Ratio (OR) = 0.38, p = 0.03); there were too many small group sessions facilitated only by students resulting in an unclear curriculum (OR = 0.04, p < 0.0001); and that there was a lack of opportunity to explore academic subjects of interest (OR = 0.40, p = 0.02). They were significantly more likely to disagree that: there was a lack of encouragement from teachers (OR = 3.11, p = 0.02); and that the medical course fostered a sense of anonymity and feelings of isolation amongst students (OR = 3.42, p = 0.008). Conclusion: There are significant differences in the perceived course-related stressors affecting medical students on PBL and non-PBL programmes. Course designers and student support services should therefore tailor their work to minimise, or help students cope with, the specific stressors on each course type to ensure optimum learning and wellbeing among our future doctors

Effect of a Perioperative, Cardiac Output-Guided Hemodynamic Therapy Algorithm on Outcomes Following Major Gastrointestinal Surgery A Randomized Clinical Trial and Systematic Review

Importance: small trials suggest that postoperative outcomes may be improved by the use of cardiac output monitoring to guide administration of intravenous fluid and inotropic drugs as part of a hemodynamic therapy algorithm.Objective: to evaluate the clinical effectiveness of a perioperative, cardiac output–guided hemodynamic therapy algorithm.Design, setting, and participants: OPTIMISE was a pragmatic, multicenter, randomized, observer-blinded trial of 734 high-risk patients aged 50 years or older undergoing major gastrointestinal surgery at 17 acute care hospitals in the United Kingdom. An updated systematic review and meta-analysis were also conducted including randomized trials published from 1966 to February 2014.Interventions: patients were randomly assigned to a cardiac output–guided hemodynamic therapy algorithm for intravenous fluid and inotrope (dopexamine) infusion during and 6 hours following surgery (n=368) or to usual care (n=366).Main outcomes and measures: the primary outcome was a composite of predefined 30-day moderate or major complications and mortality. Secondary outcomes were morbidity on day 7; infection, critical care–free days, and all-cause mortality at 30 days; all-cause mortality at 180 days; and length of hospital stay.Results: baseline patient characteristics, clinical care, and volumes of intravenous fluid were similar between groups. Care was nonadherent to the allocated treatment for less than 10% of patients in each group. The primary outcome occurred in 36.6% of intervention and 43.4% of usual care participants (relative risk [RR], 0.84 [95% CI, 0.71-1.01]; absolute risk reduction, 6.8% [95% CI, ?0.3% to 13.9%]; P?=?.07). There was no significant difference between groups for any secondary outcomes. Five intervention patients (1.4%) experienced cardiovascular serious adverse events within 24 hours compared with none in the usual care group. Findings of the meta-analysis of 38 trials, including data from this study, suggest that the intervention is associated with fewer complications (intervention, 488/1548 [31.5%] vs control, 614/1476 [41.6%]; RR, 0.77 [95% CI, 0.71-0.83]) and a nonsignificant reduction in hospital, 28-day, or 30-day mortality (intervention, 159/3215 deaths [4.9%] vs control, 206/3160 deaths [6.5%]; RR, 0.82 [95% CI, 0.67-1.01]) and mortality at longest follow-up (intervention, 267/3215 deaths [8.3%] vs control, 327/3160 deaths [10.3%]; RR, 0.86 [95% CI, 0.74-1.00]).Conclusions and relevance: in a randomized trial of high-risk patients undergoing major gastrointestinal surgery, use of a cardiac output–guided hemodynamic therapy algorithm compared with usual care did not reduce a composite outcome of complications and 30-day mortality. However, inclusion of these data in an updated meta-analysis indicates that the intervention was associated with a reduction in complication rate

The Lord Howe Island Rodent Eradication: Lessons Learnt from an Inhabited Island

The 2019 rodent eradication on 1,455-ha Lord Howe Island was the second and largest attempted on a permanently inhabited island. With 350 residents, it presented numerous novel challenges, resulting in an operation best summarised in four words: Compromise, Commensal, Complexity, and Cost. A ground-based operation was conducted across the built-up portion of the island, some 300 ha, with aerial bait applied on forested higher ground (1,200 ha); brodifacoum was used exclusively for this attempted eradication. Initial community resistance and the presence of mice meant that almost 19,000 external bait stations were established within the Settlement, on a 10-m grid. The intensive grid was expected to result in numerous bait stations within rodents’ home ranges. An additional 3,500 internal bait stations were put in all buildings and 9,500 hand-broadcast points overlapped the aerial and bait station boundaries. Over 60 field staff were employed locally, from Australia and overseas, to run the toxic baiting operation for 5.3 months. On-going resistance from a small community group resulted in two legal challenges early in the operational stage, including one in the Australian Supreme Court. Additional complications included initial active opposition to private land access; unaccepted personnel by the private land owners; resistance to livestock removal requiring novel bait station infrastructure; possible significant bait loss to invertebrates; and a small proportion of rats apparently avoiding bait stations. A fundamental aim of future operations on inhabited islands should be that they are community-led, which is likely to take several years to mature to the operational stage. Eradication practitioners should prepare for a significantly more complex operation with a concomitant increase in resourcing and planning

Invasion of yellow crazy ant Anoplolepis gracilipes in a Seychelles UNESCO palm forest

The mature palm forest of the Vallée de Mai, a UNESCO World Heritage Site, on the Seychelles island of Praslin, is a unique ecosystem containing many endemic species, including the iconic coco de mer palm Lodoicea maldivica. In 2009, the invasive yellow crazy ant Anoplolepis gracilipes was recorded for the first time within the palm forest, raising concern about its potential impacts on the endemic fauna. This research aimed to: (1) assess the current distribution and spread of A. gracilipes within the palm forest; (2) identify environmental variables that are linked to A. gracilipes distribution; and (3) compare endemic species richness and abundance in A. gracilipes invaded and uninvaded areas. Anoplolepis gracilipes was confined to the north-east of the site and remained almost stationary between April 2010 and December 2012, with isolated outbreaks into the forest. Infested areas had significantly higher temperature and humidity and lower canopy cover. Abundance and species richness of the endemic arboreal fauna were lower in the A. gracilipes invaded area. Molluscs were absent from the invaded area. The current restricted distribution of A. gracilipes in this ecosystem, combined with lower abundance of endemic fauna in the invaded area, highlight the need for further research to assess control measures and the possible role of biotic resistance to the invasion of the palm forest by A. gracilipes

Distribution and enrichment of trace metals in benthic, estuarine sediments: Southport Broadwater, Australia

The distribution and enrichment of selected trace metals (Cd, Cr, Cu, Ni, Pb, Sn, Zn) in benthic sediments of the Southport Broadwater, a semi-enclosed coastal body of water adjacent to the Gold Coast city, south-eastern Queensland, Australia, was studied with the objective of assessing the extent and degree of sediment contamination. Sediment samples from the 0–10 cm and 10–20 cm depth intervals of 32 sites within the Southport Broadwater and surrounding residential canals were analysed for particle size distribution, pH, organic C and ‘near-total’ major (Al, Ca, Fe, Mn) and trace (Cd, Cr, Cu, Ni, Pb, Sn, Zn) metal contents. Sediment contamination for each trace metal was assessed by (1) comparison with Australian sediment quality guidelines, (2) calculation of the index of geoaccumulation based on regional background values, and (3) geochemical normalisation against Al (i.e. the abundance of alumino-silicate clay minerals). Based on this approach, the results indicate that submerged sediments in the study area are not presently enriched with Cd, Cr or Ni, with the spatial distribution of these metals being very well explained by the abundance of alumino-silicate clay minerals. However, several sites were strongly enriched with Cu, Pb, Sn and Zn, arising from sources related to either urban runoff or vessel maintenance activities. The study indicates that several varying approaches are needed for a satisfactory assessment of contaminant enrichment in estuarine sediments