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The critical significance of probability distributions in the analysis of real-world phenomena is broadly recognized; however, there is a lack of probability distributions capable of effectively modeling practical data sets. In the quest to analyze real data, researchers often strive to discover new and more effective statistical models. Consequently, numerous probability-based methodologies are created and applied. A majority of these methodologies rely on the introduction of new parameters, which can occasionally result in re-parameterizations. Focusing on this particular research domain, we unveil a new statistical methodology intended to enhance the distributional flexibility of probability distributions. This methodology, which incorporates arcsine and sine functions, is known as the arcsine-sine-G (ASS-G) method. Informed by the ASS-G method, a new variant of the exponentiated exponential distribution has been established, called the arcsine-sine-exponentiated exponential (ASSE-exponential) distribution. Estimators associated with the ASSE-exponential distribution have been successfully obtained. Their performance is scrutinized through a simulation study. In addition, properties concerning quartiles and identifiability are derived. Ultimately, the relevance of the ASSE-exponential distribution is established by examining two data sets sourced from music therapy and reliability engineering. Based on certain evaluation tests, we show the fitting performance of the ASSE-exponential distribution against the rival models.

Multimodal emotion recognition is widely used in fields such as music emotion analysis and intelligent interaction. However, current models still face challenges in real-time and accuracy, especially in multimodal data fusion and emotional fluctuation processing. To this end, this paper proposes a real-time emotion recognition model based on Bi-LSTM and feature fusion, which effectively improves the capture efficiency of emotional features through multi-modal feature compression and adaptive sampling technology. The Bi-LSTM network is used to mine the time dependence of multi-modal data, while the feature fusion module integrates key emotional features in audio, visual and physiological signals, allowing the model to achieve a good balance between accuracy and real-time performance. Experimental results show that this model achieves higher accuracy and lower latency on the DEAP and AMIGOS data sets. Compared with existing methods, it has significant performance in multiple indicators such as weighted F1 score and G-Mean accuracy. To improve. Ablation experiments further confirmed that Bi-LSTM, feature fusion and adaptive sampling modules respectively make important contributions to the robustness and real-time performance of the model in emotion recognition tasks. This research provides an effective solution for multi-modal emotion recognition tasks, verifies the application potential of multi-modal feature fusion technology in music emotion analysis, and provides theoretical and practical support for the optimization of future emotional computing systems.

As the global population continues to grow, so does the demand for food. However, cold stress due to global climate change greatly threatens the safe production of rice. Piriformospora indica plays a pivotal role as a functional microbiota in improving cold tolerance in rice. However, the addition of P. indica alone has a limited effect. In this study, an attempt was made to select plant growth-promoting bacteria (Agrobacterium rhizogenes and Bacillus subtilis) as helper bacteria to help P. indica function better and further enhance rice cold tolerance. Under cold stress, the co-addition of the three beneficial microorganisms significantly increased the biomass, photosynthetic performance indicators, osmoregulatory substance contents, and antioxidant enzyme activities of rice. P. indica and helper bacteria significantly reduced the cold stress-induced increases in malondialdehyde content and electrolyte leakage rate in rice leaves and triggered a substantial upregulation of cold-tolerant genes in rice. This suggests that P. indica and helper bacteria can synergistically improve the cold resistance of rice. The findings of the research offer a conceptual foundation and practical assistance for enhancing rice's resilience to cold temperatures.

Soil salinization is one of the major factors limiting agricultural production. Utilizing beneficial microorganisms like Piriformospora indica (P. indica) to enhance plant tolerance to abiotic stresses is a highly effective method, but the influence of P. indica on the growth of soybean in natural saline-alkaline soil remains unclear. Therefore, we investigated the effects of non-inoculation, P. indica inoculation, and fertilization on the growth, antioxidant defense, osmotic adjustment, and photosynthetic gas exchange parameters of soybean under two different levels of saline-alkaline stress in non-sterilized natural saline-alkaline soil. The study found that: 1) P. indica inoculation significantly promoted soybean growth, increasing plant height, root length, and biomass. Under mildly saline-alkaline stress, the increases were 11.5%, 16.0%, and 14.8%, respectively, compared to non-inoculated treatment. Under higher stress, P. indica inoculation achieved the same level of biomass increase as fertilization, while fertilization only significantly improved stem diameter. 2) Under saline-alkaline stress, P. indica inoculation significantly increased antioxidant enzyme activities and reduced malondialdehyde (MDA) content. Under mildly stress, MDA content was reduced by 47.1% and 43.3% compared to non-inoculated and fertilized treatments, respectively. Under moderate stress, the MDA content in the inoculated group was reduced by 29.9% and 36.6% compared to non-inoculated and fertilized treatments, respectively. Fertilization only had a positive effect on peroxidase (POD) activity. 3) P. indica inoculation induced plants to produce more osmotic adjustment substances. Under mildly stress, proline, soluble sugars, and soluble proteins were increased by 345.7%, 104.4%, and 6.9%, respectively, compared to non-inoculated treatment. Under higher stress, the increases were 75.4%, 179.7%, and 12.6%, respectively. Fertilization had no significant positive effect on proline content. 4) With increasing stress, soybean photosynthetic capacity in the P. indica-inoculated treatment was significantly higher than in the non-inoculated treatment, with net photosynthetic rate increased by 14.8% and 37.0% under different stress levels. These results indicate that P. indica can enhance soybean’s adaptive ability to saline-alkaline stress by regulating ROS scavenging capacity, osmotic adjustment substance content, and photosynthetic capacity, thereby promoting plant growth. This suggests that P. indica has great potential in improving soybean productivity in natural saline-alkaline soils.

This study aimed to investigate the effect of varying levels of dietary protein on digestion, metabolism, serum biochemical indexes, and rumen microflora in Lanzhou fat-tailed sheep. A total of twenty 8-month-old healthy rams with an initial average body weight (BW 25.16 ± 1.09 kg) were selected and randomly divided into four dietary treatments with different protein levels P: 9.47%, MP: 10.53%, HP: 11.56%, and EHP: 12.61%. The rams underwent a 23 day adaptation period, and the experiment was conducted for 7 d. The results showed that with increased dietary protein levels, the apparent digestibility of dry matter (DM), crude protein (CP), acid detergent fiber (ADF), and urine energy significantly increased (p < 0.05), increasing by 8.65%, 7.31%, 6.22%, and 0.1%, respectively. In contrast, the digestibility of neutral detergent fiber (NDF) first increased and then plateaued with the increase in protein levels, and the digestibility of NDF in the HP group was the highest (p < 0.05). The Shannon, Simpson, Chao1, and Ace indices of rumen microorganisms in the four groups did not change significantly (p > 0.05). Additionally, at the phylum level, the relative abundance of Bacteroidota, Firmicutes, and Verrucomicrobiota collectively accounted for over 91% of the total phylum composition. At the genus level, there was an increase in the relative abundance of uncultured_rumen_bacterium and Rikenellaceae_RC9_gut_group in the LP group, whereas the relative abundance of Prevotella decreased. In comparison to the other three groups, the HP group exhibited an increase in the relative abundance of Firmicutes. In summary, dietary protein level had no significant effects on the rumen microflora structure and blood biochemical indexes. However, diets with a high protein level can improve the apparent digestibility of nutrients and energy use efficiency of Lanzhou fat-tailed sheep.

Abstract Background Although life satisfaction is a predictor of depressive and anxiety symptoms, the mechanisms underlying this association are poorly understood. This study examined how psychological capital (PsyCap), a positive psychological state, mediated the association between life satisfaction and depressive and anxiety symptoms among Chinese medical students during the COVID-19 pandemic. Methods A cross-sectional survey was conducted at three medical universities in China. A self-administered questionnaire was distributed to 583 students. Depressive symptoms, anxiety symptoms, life satisfaction, and PsyCap were measured anonymously. A hierarchical linear regression analysis was performed to explore the effects of life satisfaction on depressive and anxiety symptoms. Asymptotic and resampling strategies were used to examine how PsyCap mediates the association between life satisfaction and depressive and anxiety symptoms. Results Life satisfaction was positively associated with PsyCap and its four components. There were significant negative associations between life satisfaction, psychological capital, resilience, optimism, and depressive and anxiety symptoms among medical students. Self-efficacy was negatively associated with depressive and anxiety symptoms. Psychological capital (a×b = -0.3201, BCa 95% CI: -0.3899, -0.2446; a×b = -0.2749, BCa 95% CI: -0.3817, -0.1996), resilience (a×b = -0.2103, BCa 95% CI: -0.2727, -0.1580; a×b = -0.1871, BCa 95% CI: -0.2520, -0.1414), optimism (a×b = -0.2100, BCa 95% CI: -0.3388, -0.1150; a×b = -0.1998, BCa 95% CI: -0.3307, -0.0980), and self-efficacy (a×b = -0.0916, BCa 95% CI: 0.0048, 0.11629; a×b = 0.1352, BCa 95% CI: 0.0336, 0.2117) significantly mediated the association between life satisfaction and depressive and anxiety symptoms. Limitations This was a cross-sectional study, and causal relationships between the variables could not be ascertained. Self-reported questionnaire instruments were used for data collection, which may have recall bias. Conclusions Life satisfaction and PsyCap can be used as positive resources to reduce depressive and anxiety symptoms among third-year Chinese medical students during the COVID-19 pandemic. Psychological capital and its components (self-efficacy, resilience, and optimism) partially mediated the relationship between life satisfaction and depressive symptoms, and completely mediated the relationship between life satisfaction and anxiety symptoms. Therefore, improving life satisfaction and investing in psychological capital (especially self-efficacy, resilience, and optimism) should be included in the prevention and treatment of depressive and anxiety symptoms among third-year Chinese medical students. Additional attention is needed to pay for self-efficacy in such disadvantageous contexts.

The green and low-carbon transformation of land use (GLTLU) is a pressing global issue that requires urgent attention. The digital economy has emerged as a new driver for the GLTLU. However, current research mainly focuses on the measurement and environmental effects of the digital economy, with less exploration of how the digital economy influences the spatial effects and regulatory mechanisms of GLTLU, particularly regarding the differential impacts and specific mechanisms at the regional level. This study uses panel data from 283 cities in China from 2011 to 2019, employing the spatial Durbin model (SDM) and the panel threshold model to examine the spatial and regulatory mechanisms of the digital economy’s impact on GLTLU. The findings reveal that digital economy promotes GLTLU not only within cities but also in surrounding regions. Robustness analyses support this conclusion. Notably, the digital economy’s positive impact on GLTLU in surrounding areas is confined to the central region of China. In contrast, the Yangtze River Delta urban agglomeration experiences a significant negative impact on GLTLU in nearby regions due to the digital economy. The study also identifies that the positive spatial spillover effect of the digital economy on GLTLU reaches its peak at a distance of 450 km. Additionally, the digital economy’s ability to promote GLTLU is contingent upon financial agglomeration levels exceeding 9.1728. Moreover, the local government’s emphasis on the digital economy and intellectual property protection enhances the digital economy’s impact on GLTLU. The promotion effect is maximized when these factors surpass the thresholds of 27.8054 and 3.5189, respectively. Overall, this study contributes to the understanding of how the digital economy influences sustainable land development, highlighting the critical role of regional factors and regulatory mechanisms in amplifying the digital economy’s positive effects on GLTLU.

Regional wall motion abnormality (RWMA) is a common manifestation of ischemic heart disease detected through echocardiography. Currently, RWMA diagnosis heavily relies on visual assessment by doctors, leading to limitations in experience-based dependence and suboptimal reproducibility among observers. Several RWMA diagnosis models were proposed, while RWMA diagnosis with more refined segments can provide more comprehensive wall motion information to better assist doctors in the diagnosis of ischemic heart disease. In this paper, we proposed the STGA-MS model which consists of three modules, the spatial-temporal grouping attention (STGA) module, the segment feature extraction module, and the multiscale downsampling module, for the diagnosis of RWMA for multiple myocardial segments. The STGA module captures global spatial and temporal information, enhancing the representation of myocardial motion characteristics. The segment feature extraction module focuses on specific segment regions, extracting relevant features. The multiscale downsampling module analyzes myocardial motion deformation across different receptive fields. Experimental results on a 2D transthoracic echocardiography dataset show that the proposed STGA-MS model achieves better performance compared to state-of-the-art models. It holds promise in improving the accuracy and reproducibility of RWMA diagnosis, assisting clinicians in diagnosing ischemic heart disease more reliably.

Abstract Background Owing to the coronavirus disease 2019, medical learning burnout has attracted increasing attention in educational research. It has a serious negative impact on medical students and their service quality. This could impair the professional development of medical students; weaken their personal and professional quality; and lead to problems such as increased medical errors and reduced patient care quality and satisfaction. This study aimed to examine the effects of perceived stress, social support, and the Big Five personality traits on learning burnout among medical students. Methods In November 2021, a cross-sectional survey was conducted at three medical universities in China. A self-administered questionnaire was distributed to 616 third- year students. Learning burnout, perceived stress, social support, and the Big Five personality traits (neuroticism, extroversion, openness, agreeableness, and conscientiousness) were anonymously measured. A total of 583 students were included in the final sample. Hierarchical linear regression was performed to explore the effects of perceived stress, social support, and Big Five personality traits on medical students’ learning burnout. Results Perceived stress was positively associated with learning burnout (emotional exhaustion: ß = 0.577, p < 0.001; cynicism: ß = 0.543, p < 0.001; low professional efficacy: ß = 0.455, p < 0.001) whereas social support was negatively related with it (low professional efficacy: ß = -0.319, p < 0.001). Neuroticism had a positive effect on emotional burnout (ß = 0.152, p = 0.009). Extraversion (ß = -0.116, p = 0.006) and conscientiousness (ß = -0.363, p < 0.001) had a negative effect on low professional efficacy. Agreeableness negatively affected emotional exhaustion (ß = -0.181, p < 0.001) and cynicism (ß = -0.245, p < 0.001) and positively affected low professional efficacy (ß = 0.098, p = 0.008). The associated factors together accounted for an additional variance of learning burnout (emotional exhaustion: 39.0%; cynicism: 36.8%; low professional efficacy: 48.7%). Conclusions Social support is a positive resource for fighting medical students’ burnout. Perceived stress was the strongest indicator of learning burnout. In addition to reducing perceived stress, developing extraversion, agreeableness, and conscientiousness should be included in burnout prevention and treatment strategies, particularly for medical students.

Abstract Background Smartphone addiction bodes adverse consequences, affecting different populations, including medical students. Parental bonding in childhood had been associated with addiction and recovery in later life. Therefore, this study aimed to examine the associations between parental bonding and smartphone addiction among Chinese medical students. Method Binary logistic regressions were used to investigate the associations between parental bonding with mothers and fathers, respectively, and smartphone addiction. Interaction terms of care and protection were included in the models. Results A total of 517 medical students were included in the study. The prevalence of smartphone addiction was 48.16% (n = 249). The estimated effects of maternal and paternal parenting on smartphone addiction differed. Maternal protection was positively associated with smartphone addiction (OR, 1.046;95% CI, 1.005-1.087), and maternal care enhanced the estimated effect of protection on smartphone addiction. Paternal care was negatively associated with smartphone addiction (OR, 0.954;95% CI, 0.919-0.989). Conclusions Chinese medical students with overprotective mothers or with indifferent fathers tended to exhibit traits of smartphone addiction. Further studies on factors influencing the associations between parental bonding and smartphone addiction may pave the way for potential family-oriented interventions for smartphone addiction.

BackgroundAcademic procrastination has become more prevalent during the COVID-19 pandemic due to teaching/learning changes. This phenomenon induces academic burnout, which is already serious among medical students. However, the academic emotion, which is the factor most vulnerable to changes in the academic environment, is still unknown. Therefore, the current study aimed to investigate the mediating role of general academic emotions in procrastination and burnout among Chinese medical students during the COVID-19 pandemic.MethodsThis cross-sectional study enrolled 995 medical students from China Medical University. We applied the Chinese version of the Maslach Burnout Inventory Student Survey (MBI-SS), the Aitken Procrastination Inventory (API) and the General Academic Emotion Questionnaire for College Students (GAEQ) to evaluate the variables of interest. We examined the mediation effects of GAEs by hierarchical linear regression analysis.ResultsCorrelation analyses showed a significant positive correlation between procrastination and burnout. Procrastination and burnout positively and negatively correlated with negative academic emotions, respectively. Hierarchical linear regression analyses showed that procrastination had positive associations with negative academic emotions, while it had negative associations with positive academic emotions. The contributions (as mediators) of GAEs to burnout and procrastination were 21.16% (NAEs), 29.75% (PAEs), 54.25% (NDEs) and 23.69% (PDEs).ConclusionsThe results indicate that academic emotions had mediating effects on procrastination and burnout. Medical students' worries about the uncertainty of the learning environment may have exacerbated academic burnout. Targeted improvements in the teaching environment to communicate encouragement and reduce anxiety and helplessness among medical undergraduates for implementing medical education while preventing and controlling the infection.

BackgroundWeChat is the main social platform in China, characterized by its versatility and ease of communication. This study aimed to explore the effect of a WeChat-platform-based education and care (WBEC) program on relieving anxiety, depression, and post-traumatic stress disorder (PTSD) in parents of pediatric and adolescent patients with osteosarcoma.MethodsIn total, 48 patients and 86 parents were enrolled in this randomized, controlled study and then assigned to the WBEC program (24 patients and 45 parents) and the usual education and care (UEC) program (22 patients and 41 parents) for 6 months as a 1:1 ratio.ResultsParents in the WBEC group had lower Hospital Anxiety and Depression Scale (HADS) for anxiety (HADS-A) scores at M3 (7.8 ± 2.2 vs. 9.1 ± 2.5; p = 0.010) and M6 (7.7 ± 2.5 vs. 8.9 ± 2.4; p = 0.027) when compared to the UEC group, while anxiety rate was only decreased at M3 (43.2% vs. 63.4%; p = 0.049) in the WBEC group. Meanwhile, parental HADS for depression (HADS-D) scores were reduced at M3 (7.0 ± 2.0 vs. 8.0 ± 2.1; p = 0.047) and M6 (7.1 ± 1.9 vs. 8.0 ± 2.4; p = 0.045) in the WBEC group when compared with the UEC group; while depression rate remained the same. Parental Impact of Event Scale-Revised (IES-R) scores were slightly reduced among the WBEC group at M6 when compared with the UEC group [12.0 (interquartile range (IQR): 10.0–20.8] vs. 15.0 (IQR: 9.5–25.0; p = 0.077)], but not statistically significant.ConclusionWeChat-platform-based education and care is considered a feasible intervention to reduce anxiety and depression in parents of pediatric and adolescent patients with osteosarcoma, while also providing mild relief from PTSD.

Abstract Background Longitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. LICs use educational continuity to benefits students’ clinical learning and professional identity formation. Patient-centered care is a core component of medical professionalism in the West. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship in East Asia. We aimed to investigate patients’ perceptions of longitudinal relationships with the LIC students within Taiwan’s Confucian cultural and social context. Methods We invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients’ descriptions of their experiences interacting with the LIC students. Results Twenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients’ experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients’ experience, feelings, and mood. Conclusion In our study, Taiwanese patients’ perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.

Mental health problems are frequent obstacles in medical students’ careers as doctors. Given that previous studies overlook the mediation of stress perception, the current study expanded previous goal orientation researches by addressing an unexplored mechanism. This study aims to examine the mediational roles of stress perception (perceived stressors and stress-related cognition) on the relationship between achievement goal orientation and depression in medical students. A total of 1,015 Chinese 2-year medical students completed a multi-section questionnaire. Hypotheses were examined by structural equation modeling. The findings suggest that performance-avoidance goal orientation and perceived stressors both demonstrated direct facilitative effects on depression, whereas stress-related cognition demonstrated direct obstructive effects on depression. Both perceived stressors and stress-related cognition mediated the relationship between achievement goal orientation and depression. The findings spark a new perspective on motivational intervention that assist students in adopting mastery-approaching strategy as well as ways of coping with stressful academic situations. Identifying students with achievement goal orientation and providing them with the appropriate supportive services may help them to manage stress and mitigate or prevent depression.

Objectives Early professionalism education for first-year students is important for generating sound knowledge and attitudes towards medical professionalism. Of the many factors affecting professionalism and professional identity formation in medical students, career choice motivation is an understudied one. This study aimed to explore the relationship between the career choice motivations of first-year medical students and their understanding of professionalism.Settings and participants A cross-sectional survey of 940 first-year clinical medicine students was conducted at China Medical University in September 2017 to explore students’ motivation to study medicine and its relationship with students’ understanding of professionalism. Demographics, career choice motivation and professionalism were obtained through paper questionnaires. Logistic regression analysis was used to analyse the association between career choice motivation and understanding of professionalism while controlling for potential demographic confounders.Results The most common career choice motivations for first-year medical students (N=843) were interested in the health sciences, income and social status and advocating altruism. The most mentioned subdimensions of professionalism were accountability, pursuit of excellence and compassion. There were significant differences in the understanding of professionalism among students with different career choice motivations.Conclusion First-year medical students with different motivations to study medicine also have different understandings of professionalism. Medical educators can explore motivations to learning medicine as a new entry point to providing professionalism education for newly enrolled medical students.

Abstract Background Although it has been nearly 15 years since the Medical Professionalism in the New Millennium: A Physician Charter (the Physician Charter) was proposed to reaffirm medical professionalism in response to the new challenges in healthcare delivery in the new century, the manner in which Chinese medical students agree with and fulfill the principles and responsibilities of professionalism defined in the Physician Charter still remains unknown. Methods In March 2016, 748 fifth-year medical students from China Medical University (CMU) participated in a survey in which they indicated their rate of agreement with and manner of fulfillment of the principles and responsibilities defined in the Physician Charter using a 10-point Likert scale. The data were then analyzed by t-tests, exploratory factor analysis, and multiple linear regressions. Results The total score of agreement with the Physician Charter was significantly higher than that of fulfillment (p

Background: Medical residents usually suffer from work overload and experience both personal and professional distress, which affects their level of the empathy to patients. Psychological capital (PsyCap) is a psychological resource that is negatively associated with indicators of distress. Objective: This study explored the potential mediating effect of PsyCap on the relationship between distress and empathy, which may help healthcare professionals in their defense of empathy erosion due to distress. Design: A total of 620 first-year residents were recruited for this cross-sectional survey. Empathy and PsyCap of residents were assessed by the Chinese version of the Jefferson Scale of Physician Empathy and the Psychological Capital Questionnaire, respectively. In this study, both personal and professional aspects contributing to resident distress were investigated by the Satisfaction with Life Scale and an occupational distress scale. T-tests and one-way ANOVA were used to test differences in empathy of residents. Pearson’s correlation was used to examine correlations between distress, PsyCap, and empathy. Structured equation modeling was used to conduct the pathway analysis to test the mediating effect of PsyCap on the association between distress and empathy. Results: 537 residents (86.6%) completed the survey. Distress, empathy, and PsyCap were significantly correlated (P

Background: Medical students struggle with heavy workloads and face unique time management challenges, calling for insight on medical students’ time use in out-of-class activities and related psychological factors. Objectives: To investigate Chinese medical students’ time use in out-of-class activities and its association with self-efficacy and perceived stress. Design: 940 second-year medical students were invited to participate in the survey. A questionnaire was developed to investigate the amount of time participants spent on out-of-class activities. Two existing instruments were used to assess participants’ self-efficacy and perceived stress. Descriptive statistics and logistic regression were used to analyze the data. Results: 686 students (72.98%) completed the survey. On average, students spent about 14.4 hours per week (HPW) preparing for class and studying, 13.8 HPW on leisure and recreation, 4.8 HPW on physical exercise, 4.1 HPW on student clubs, 1.9 HPW on volunteering, and 1.9 HPW on part-time jobs on/off-campus. After controlling for demographic factors, higher self-efficacy was associated with more time preparing for class and studying (OR = 1.29, 95%CI: 1.10 ~ 1.52). Higher perceived stress was associated with less time preparing for class and studying (OR = 0.84, 95%CI: 0.72 ~ 0.98), exercising (OR = 0.82, 95%CI: 0.69 ~ 0.97), and volunteering (OR = 0.81, 95%CI: 0.67 ~ 0.97). Conclusions: Chinese medical students reported more time spent on preparing for class and studying and less time spent on volunteering and part-time jobs on/off-campus. Time spent preparing for class and studying was associated with higher self-efficacy and lower perceived stress, while perceived stress was also associated with less time spent on physical exercise and volunteering. Medical schools may need to employ measures to develop their students’ self-efficacy and maintain a relatively low level of perceived stress, especially in students who also have a low level of self-efficacy.

Objectives To administer a cross-cultural adaptation of the Team Interaction Scale (TIS), test its psychometric properties and investigate influencing factors of team interactions in a physician population in Chinese tertiary hospitals.Design Cross-sectional survey.Settings Two rounds of surveys, a pilot and a large sampling survey, were conducted in two and nine tertiary hospitals, respectively, in Liaoning Province, China.Participants In the pilot survey, 363 of 390 physicians sampled were included in the analysis, resulting in an effective response rate of 93.08%. In the large sampling survey, the effective response rate was 89.10% (3653 of 4100 physicians).Outcome measures The TIS and a short version of a burn-out scale were administrated to assess the physician’s team interaction and burn-out. Psychometric properties of TIS were tested by confirmatory factor analysis (CFA), exploratory factor analysis (EFA) and internal consistency analysis. Gender, age, discipline, education level, professional title, hospital scale and burn-out were explored as influencing factors with independent sample t-tests, one-way analyses of variance and a correlation analysis.Results Based on CFA, a 17-item modified scale was developed following the pilot survey. In the large sampling survey, EFA was conducted with half of the samples, producing six dimensions: ‘Communication’, ‘Coordination’, ‘Mutual help’, ‘Team goals’, ‘Work norms’ and ‘Cohesion and conflict resolution’. Fit of the modified model was confirmed by CFA with the other half of the samples (root mean square error of approximation=0.067, Comparative Fit Index=0.98, Normed Fit Index=0.97, Goodness of Fit Index=0.94, Adjusted Goodness of Fit Index=0.92). A high Cronbach’s α coefficient of 0.98 demonstrated reliability of the modified scale. The Team Interaction Score was significantly lower in younger physicians, in men, in paediatricians and in physicians from larger-scale tertiary hospitals. Team Interaction Scores were negatively associated with burn-out.Conclusions The adapted TIS, containing 17 items and six dimensions, was reliable and valid for Chinese tertiary hospital physicians. To address physician burn-out, team interaction should be highlighted.

BACKGROUND:Over the last three decades, various instruments were developed and employed to assess medical professionalism, but their measurement properties have yet to be fully evaluated. This study aimed to systematically evaluate these instruments' measurement properties and the methodological quality of their related studies within a universally acceptable standardized framework and then provide corresponding recommendations. METHODS:A systematic search of the electronic databases PubMed, Web of Science, and PsycINFO was conducted to collect studies published from 1990-2015. After screening titles, abstracts, and full texts for eligibility, the articles included in this study were classified according to their respective instrument's usage. A two-phase assessment was conducted: 1) methodological quality was assessed by following the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist; and 2) the quality of measurement properties was assessed according to Terwee's criteria. Results were integrated using best-evidence synthesis to look for recommendable instruments. RESULTS:After screening 2,959 records, 74 instruments from 80 existing studies were included. The overall methodological quality of these studies was unsatisfactory, with reasons including but not limited to unknown missing data, inadequate sample sizes, and vague hypotheses. Content validity, cross-cultural validity, and criterion validity were either unreported or negative ratings in most studies. Based on best-evidence synthesis, three instruments were recommended: Hisar's instrument for nursing students, Nurse Practitioners' Roles and Competencies Scale, and Perceived Faculty Competency Inventory. CONCLUSION:Although instruments measuring medical professionalism are diverse, only a limited number of studies were methodologically sound. Future studies should give priority to systematically improving the performance of existing instruments and to longitudinal studies.