Interventions to promote medical student well-being: an overview of systematic reviews.

OBJECTIVE: To conduct an overview of systematic reviews that explore the effectiveness of interventions to enhance medical student well-being. DESIGN: Overview of systematic reviews. DATA SOURCES: The Cochrane Library of Systematic Reviews, MEDLINE, APA PsychInfo, CINAHL and Scopus were searched from database inception until 31 May 2023 to identify systematic reviews of interventions to enhance medical student well-being. Ancestry searching and citation chasing were also conducted. DATA EXTRACTION AND SYNTHESIS: The Assessing the Methodological Quality of Systematic Reviews V.2 tool was used to appraise the quality of the included reviews. A narrative synthesis was conducted, and the evidence of effectiveness for each intervention was rated. RESULTS: 13 reviews (with 94 independent studies and 17 616 students) were included. The reviews covered individual-level and curriculum-level interventions. Individual interventions included mindfulness (n=12), hypnosis (n=6), mental health programmes (n=7), yoga (n=4), cognitive and behavioural interventions (n=1), mind-sound technology (n=1), music-based interventions (n=1), omega-3 supplementation (n=1), electroacupuncture (n=1) and osteopathic manipulative treatment (n=1). The curriculum-level interventions included pass/fail grading (n=4), problem-based curriculum (n=2) and multicomponent curriculum reform (n=2). Most interventions were not supported by sufficient evidence to establish effectiveness. Eleven reviews were rated as having 'critically low' quality, and two reviews were rated as having 'low' quality. CONCLUSIONS: Individual-level interventions (mindfulness and mental health programmes) and curriculum-level interventions (pass/fail grading) can improve medical student well-being. These conclusions should be tempered by the low quality of the evidence. Further high-quality research is required to explore additional effective interventions to enhance medical student well-being and the most efficient ways to implement and combine these for maximum benefit.

Stercoral Colitis: An Unexpected Presentation in a Young Adolescent.

Stercoral colitis is an uncommon inflammatory condition primarily affecting individuals with chronic constipation, immobilization, and advanced age, occasionally manifesting in pediatric patients. It arises from the accumulation of impacted fecal matter, leading to colonic distension and subsequent fecaloma formation, culminating in pressure necrosis and perforation. Mortality rates can exceed 60% in vulnerable populations due to complications such as colonic perforation and ischemia. Presented is the case of a 14-year-old female with stercoral colitis, initially presenting with diarrhea, abdominal pain, and metabolic acidosis. Despite improvement followed by a sudden deterioration, diagnostic challenges persisted, highlighting the complexity of diagnosing this condition, especially in pediatric cases. Key diagnostic criteria include vague abdominal symptoms, leukocytosis, and elevated inflammatory markers, alongside potential metabolic derangements. Imaging modalities, such as abdominal CT scans, aid in diagnosis, delineating features like colonic distension and wall thickening. Treatment strategies encompass aggressive bowel disimpaction, with endoscopic or surgical interventions reserved for refractory cases or perforations. Recognition of stercoral colitis is crucial for timely intervention, given its significant morbidity and mortality. Although typically associated with elderly or bedbound patients, the condition can also affect younger individuals, emphasizing the importance of considering it in the differential diagnosis, particularly in cases of chronic constipation. Integration of diagnostic imaging techniques facilitates accurate diagnosis, guiding appropriate therapeutic interventions and potentially mitigating adverse outcomes.

Environmental factors influence cross-talk between a heat shock protein and an oxidative stress protein modification in the lizard Gallotia galloti.

Better understanding how organisms respond to their abiotic environment, especially at the biochemical level, is critical in predicting population trajectories under climate change. In this study, we measured constitutive stress biomarkers and protein post-translational modifications associated with oxidative stress in Gallotia galloti, an insular lizard species inhabiting highly heterogeneous environments on Tenerife. Tenerife is a small volcanic island in a relatively isolated archipelago off the West coast of Africa. We found that expression of GRP94, a molecular chaperone protein, and levels of protein carbonylation, a marker of cellular stress, change across different environments, depending on solar radiation-related variables and topology. Here, we report in a wild animal population, cross-talk between the baseline levels of the heat shock protein-like GRP94 and oxidative damage (protein carbonylation), which are influenced by a range of available temperatures, quantified through modelled operative temperature. This suggests a dynamic trade-off between cellular homeostasis and oxidative damage in lizards adapted to this thermally and topologically heterogeneous environment.

The East Indies reptile tick Amblyomma helvolum Koch, 1844 (Acari: Ixodidae), taxonomy, biology and new host records, including the first record of human infestation.

Amblyomma helvolum is a widespread, generalist ectoparasite of reptiles in the oriental region, and has the potential to become highly invasive should it be inadvertently introduced outside its native range through the exotic pet trade. All life stages of A. helvolum are re-characterised morphologically and the first examples of nanism (dwarfism) and gynandromorphy (male and female tissue in one animal) for the species are described. Eighteen new hosts records are presented for A. helvolum, including the first case of human infestation. The taxonomy, distribution, ecology, phenology, disease associations, and invasion biology of the species are also discussed.

How do King Cobras move across a major highway? Unintentional wildlife crossing structures may facilitate movement.

Global road networks continue to expand, and the wildlife responses to these landscape-level changes need to be understood to advise long-term management decisions. Roads have high mortality risk to snakes because snakes typically move slowly and can be intentionally targeted by drivers.We investigated how radio-tracked King Cobras (Ophiophagus hannah) traverse a major highway in northeast Thailand, and if reproductive cycles were associated with road hazards.We surveyed a 15.3 km stretch of Highway 304 to determine if there were any locations where snakes could safely move across the road (e.g., culverts and bridges). We used recurse analyses to detect possible road-crossing events, and used dynamic Brownian Bridge Movement Models (dBBMMs) to show movement pathways association with possible unintentional crossing structures. We further used Integrated Step Selection Functions (ISSF) to assess seasonal differences in avoidance of major roads for adult King Cobras in relation to reproductive state.We discovered 32 unintentional wildlife crossing locations capable of facilitating King Cobra movement across the highway. While our dBBMMs broadly revealed underpasses as possible crossing points, they failed to identify specific underpasses used by telemetered individuals; however, the tracking locations pre- and post-crossing and photographs provided strong evidence of underpass use. Our ISSF suggested a lower avoidance of roads during the breeding season, although the results were inconclusive. With the high volume of traffic, large size of King Cobras, and a 98.8% success rate of crossing the road in our study (nine individuals: 84 crossing attempts with one fatality), we strongly suspect that individuals are using the unintentional crossing structures to safely traverse the road.Further research is needed to determine the extent of wildlife underpass use at our study site. We propose that more consistent integration of drainage culverts and bridges could help mitigate the impacts of roads on some terrestrial wildlife.

Optimisation of Nitrogen, Phosphorus, and Potassium for Soilless Production of Cannabis sativa in the Flowering Stage Using Response Surface Analysis.

Following legalisation, cannabis has quickly become an important horticultural crop in Canada and increasingly so in other parts of the world. However, due to previous legal restrictions on cannabis research there are limited scientific data on the relationship between nitrogen (N), phosphorus (P), and potassium (K) supply (collectively: NPK) and the crop yield and quality. This study examined the response of a high delta-9-tetrahydrocannabinol (THC) Cannabis sativa cultivar grown in deep-water culture with different nutrient solution treatments varying in their concentrations (mg L-1) of N (70, 120, 180, 250, 290), P (20, 40, 60, 80, 100), and K (60, 120, 200, 280, 340) according to a central composite design. Results demonstrated that inflorescence yield responded quadratically to N and P, with the optimal concentrations predicted to be 194 and 59 mg L-1, respectively. Inflorescence yield did not respond to K in the tested range. These results can provide guidance to cultivators when formulating nutrient solutions for soilless cannabis production and demonstrates the utility of surface response design for efficient multi-nutrient optimisation.

What are we doing when we perceive numbers?

Clarke and Beck rightly contend that the number sense allows us to directly perceive number. However, they unnecessarily assume a representationalist approach and incur a heavy theoretical cost by invoking "modes of presentation." We suggest that the relevant evidence is better explained by adopting a radical enactivist approach that avoids characterizing the approximate number system (ANS) as a system for representing number.

Draft Genome Sequence of the Yeast Ogataea degrootiae Strain UCD465, Isolated from Soil in Ireland.

Ogataea degrootiae is an ascomycete yeast that was first isolated in the Netherlands in 2017. It is a member of the Pichiaceae clade. Here, we present the genome sequence of O. degrootiae UCD465, which was isolated from soil in Ireland. This genome is 14.6 Mb and haploid.

Native Burmese pythons exhibit site fidelity and preference for aquatic habitats in an agricultural mosaic.

Animal movement and resource use are tightly linked. Investigating these links to understand how animals use space and select habitats is especially relevant in areas affected by habitat fragmentation and agricultural conversion. We set out to explore the space use and habitat selection of Burmese pythons (Python bivittatus) in a heterogenous, agricultural landscape within the Sakaerat Biosphere Reserve, northeast Thailand. We used VHF telemetry to record the daily locations of seven Burmese pythons and created dynamic Brownian Bridge Movement Models to produce occurrence distributions and model movement extent and temporal patterns. To explore relationships between movement and habitat selection we used integrated step selection functions at both the individual and population level. Burmese pythons had a mean 99% occurrence distribution contour of 98.97 ha (range 9.05-285.56 ha). Furthermore, our results indicated that Burmese pythons had low mean individual motion variance, indicating infrequent moves and long periods at a single location. In general, Burmese pythons restricted movement and selected aquatic habitats but did not avoid potentially dangerous land use types like human settlements. Although our sample is small, we suggest that Burmese pythons are capitalizing on human disturbed landscapes.

Can post-capture photographic identification as a wildlife marking technique be undermined by observer error? A case study using King Cobras in northeast Thailand.

Identifying individuals with natural markings is increasing in popularity to non-invasively support population studies. However, applying natural variation among individuals requires careful evaluation among target species, snakes for example have little validation of such methods. Here we introduce a mark-free identification method for King Cobras (Ophiophagus hannah) from the Sakaerat Biosphere Reserve, in northeast Thailand using both subcaudal scale pholidosis (scale arrangement and number) and unique ventral body markings to distinguish individuals. This project aims to evaluate the impact of observer error on individual identification. Observers of varying expertise, will distinguish between King Cobra individuals using identifying photographs from a previous study. We will ask randomly assigned observers to distinguish individuals via: 1) subcaudal pholidosis, 2) ventral body markings, and 3) combination of both measures. Using Bayesian logistic regression, we will assess the probability observers correctly distinguish individuals. Based on exploratory observations, we hypothesise that there will be a high probability of correct identifications using subcaudal pholidosis and ventral body markings. We aim to stimulate other studies implementing identification techniques for scrutinous assessment of such methods, in order to avoid subsequent errors during long-term population studies.

No room to roam: King Cobras reduce movement in agriculture.

BACKGROUND: Studying animal movement provides insights into how animals react to land-use changes. As agriculture expands, we can use animal movement to examine how animals change their behaviour in response. Recent reviews show a tendency for mammalian species to reduce movements in response to increased human landscape modification, but reptile movements have not been as extensively studied. METHODS: We examined movements of a large reptilian predator, the King Cobra (Ophiophagus hannah), in Northeast Thailand. We used a consistent regime of radio telemetry tracking to document movements across protected forest and adjacent agricultural areas. Using dynamic Brownian Bridge Movement Model derived motion variance, Integrated Step-Selection Functions, and metrics of site reuse, we examined how King Cobra movements changed in agricultural areas. RESULTS: Motion variance values indicated that King Cobra movements increased in forested areas and tended to decrease in agricultural areas. Our Integrated Step-Selection Functions revealed that when moving in agricultural areas King Cobras restricted their movements to remain within vegetated semi-natural areas, often located along the banks of irrigation canals. Site reuse metrics of residency time and number of revisits appeared unaffected by distance to landscape features (forests, semi-natural areas, settlements, water bodies, and roads). Neither motion variance nor reuse metrics were consistently affected by the presence of threatening landscape features (e.g. roads, human settlements), suggesting that King Cobras will remain in close proximity to threats, provided habitat patches are available. CONCLUSIONS: Although King Cobras displayed individual heterogeneity in their response to agricultural landscapes, the overall trend suggested reduced movements when faced with fragmented habitat patches embedded in an otherwise inhospitable land-use matrix. Movement reductions are consistent with findings for mammals and forest specialist species.

The rationale of rationalization.

While we agree in broad strokes with the characterisation of rationalization as a "useful fiction," we think that Fiery Cushman's claim remains ambiguous in two crucial respects: (1) the reality of beliefs and desires, that is, the fictional status of folk-psychological entities and (2) the degree to which they should be understood as useful. Our aim is to clarify both points and explicate the rationale of rationalization.

Determination of the maximum distance blood spatter travels from a vertical impact.

Bloodstain evidence can be very powerful evidence in assault related crimes. Determination of the distance that blood droplets may travel as a result of an impact into liquid blood may be of significance to corroborate or disprove a version of events, provide likely scenarios, or help determine the culpability of a person in determining their proximity to the blood shedding event. It was the aim of this research to determine the potential maximum distance blood droplets travel horizontally following a vertical impact into liquid blood. A custom apparatus was designed and constructed to replicate a vertical impact of a timber weapon, rotating on a fixed axis at one end, striking a pool of liquid blood. The device was positioned at three different levels of elevation to replicate an impact to the head of a person near ground level, a seated or kneeling height and standing height. Overall, the results indicated that the application of kinetic energy of between 1 and 5J at a height of 1780mm led to the blood droplets travelling a maximum horizontal distance of 5361mm (and average maximum distance of 4981mm). The horizontal distance blood droplets may travel upon impact does not appear to follow a linear trend with differing kinetic energy, but is affected by the applied force and release height in a curvilinear relationship. The results provide a valuable tool to bloodstain pattern analysts and investigators in determining search zones within a scene, as well as providing information about the proximity of an individual to an impact event.

The largest deep-ocean silicic volcanic eruption of the past century.

The 2012 submarine eruption of Havre volcano in the Kermadec arc, New Zealand, is the largest deep-ocean eruption in history and one of very few recorded submarine eruptions involving rhyolite magma. It was recognized from a gigantic 400-km2 pumice raft seen in satellite imagery, but the complexity of this event was concealed beneath the sea surface. Mapping, observations, and sampling by submersibles have provided an exceptionally high fidelity record of the seafloor products, which included lava sourced from 14 vents at water depths of 900 to 1220 m, and fragmental deposits including giant pumice clasts up to 9 m in diameter. Most (>75%) of the total erupted volume was partitioned into the pumice raft and transported far from the volcano. The geological record on submarine volcanic edifices in volcanic arcs does not faithfully archive eruption size or magma production.

Laser recrystallization and inscription of compositional microstructures in crystalline SiGe-core fibres.

Glass fibres with silicon cores have emerged as a versatile platform for all-optical processing, sensing and microscale optoelectronic devices. Using SiGe in the core extends the accessible wavelength range and potential optical functionality because the bandgap and optical properties can be tuned by changing the composition. However, silicon and germanium segregate unevenly during non-equilibrium solidification, presenting new fabrication challenges, and requiring detailed studies of the alloy crystallization dynamics in the fibre geometry. We report the fabrication of SiGe-core optical fibres, and the use of CO2 laser irradiation to heat the glass cladding and recrystallize the core, improving optical transmission. We observe the ramifications of the classic models of solidification at the microscale, and demonstrate suppression of constitutional undercooling at high solidification velocities. Tailoring the recrystallization conditions allows formation of long single crystals with uniform composition, as well as fabrication of compositional microstructures, such as gratings, within the fibre core.

Light trapping in horizontally aligned silicon microwire solar cells.

In this study, we demonstrate a solar cell design based on horizontally aligned microwires fabricated from 99.98% pure silicon via the molten core fiber drawing method. A similar structure consisting of 50 µm diameter close packed wires (≈ 0.97 packing density) on a Lambertian white back-reflector showed 86 % absorption for incident light of wavelengths up to 850 nm. An array with a packing fraction of 0.35 showed an absorption of 58 % over the same range, demonstrating the potential for effective light trapping. Prototype solar cells were fabricated to demonstrate the concept. Horizontal wire cells offer several advantages as they can be flexible, and partially transparent, and absorb light efficiently over a wide range of incident angles.

'National Hero and Very Queer Fish': Empire, Sexuality and the British Remembrance of General Gordon, 1918-72.

This article presents the first detailed study of General Gordon's remembrance in Britain between 1918 and 1972. Previous scholars have exaggerated the impact of Lytton Strachey's Eminent Victorians (1918). Strachey damaged Gordon's reputation, but part one reveals how several commentators forcefully rebutted Eminent Victorians; official commemorations, books, radio plays, and films celebrated Gordon in the 1930s, as empire featured prominently in mass culture. Didactic uses of his example by the state diminished after 1945, but parts 2 and 3 show how writers used Gordon's story to engage with new debates about Britain's role in the world, immigration and sexuality. The article reveals how a fascination with the sexuality of heroes inspired men as diverse as Viscount Robin Maugham and East End gangster Ronnie Kray to identify with Gordon. Maugham's works and the feature film Khartoum (1966) expressed nostalgia for empire during decolonization, but American screenwriter Robert Ardrey also drew on his experiences in the Congo to present a dark vision of African savagery in Khartoum, a vision performed at Pinewood studios by black immigrants from London's slums. The article questions Edward Berenson's emphasis on the 'charismatic aura' of heroes, emphasizing instead the diversity of engagements inspired through different genre.

Stimulus equivalence: testing Sidman's (2000) theory.

Sidman's (2000) theory regarding the origin of equivalence relations predicts that a reinforcing stimulus common to distinct equivalence classes must drop out of the equivalence relations. This prediction was tested in the present study by arranging class-specific reinforcers, R1 and R2, following correct responding on the prerequisite conditional discriminations (Ax-Bx, Cx-Bx) for two stimulus classes, A1B1C1 and A2B2C2. A class-common reinforcer, R3, was presented following correct responding on the prerequisite conditional discriminations for a further two stimulus classes, A3B3C3 and A4B4C4. Sidman's theory predicts reinforcer inclusion within Classes 1 and 2 only, given this training arrangement. Experiment 1 tested for the emergence of four equivalence classes and of stimulus-reinforcer and reinforcer-stimulus relations in each class. Four of the 6 subjects demonstrated the reinforcer-based relations in all four equivalence classes, rather than in only those classes with a class-specific reinforcer, as Sidman's theory predicts. One of the remaining 2 subjects showed the reinforcer-based relations in three of the four classes. Experiment 2 extended these findings to document the emergence of interclass matching relations based on the common reinforcer R3, in 5 of 6 subjects, such that a Class 3 sample occasioned the selection of a Class 4 sample when the Class 3 comparison was absent, and similarly, a Class 4 sample occasioned the selection of a Class 3 comparison when the Class 4 comparison was absent. These interclass relations emerged despite the simultaneous maintenance of Class 3 and 4 baseline conditional discriminations, so that the Class 3 and 4 stimuli and reinforcer simultaneously were, and were not, part of a single larger equivalence class. These data are irreconcilable with Sidman's theory, and question the utility of the application of the equivalence relation in describing derived stimulus relations.