Methods originally employed to demonstrate the heterogeneity of mast cells in the rat and more recently in the human intestine were used to study mast cell heterogeneity in the human bronchial mucosa and lung parenchyma. Thus, a quantitative survey of pulmonary mast cells using different fixation and staining procedures indicated that two distinct mast cell subpopulations (formalin-sensitive and formalin-resistant) are present and have distinct patterns of distribution and abundance. The findings are of potential clinical importance because histochemical heterogeneity may be a marker of functional mast cell differences in humans including differences in responsiveness to antiallergic drugs, as occurs in rats. The findings also indicate that conventional methods of fixation are likely to lead to a gross underestimation of total mast cell numbers.

Background Burnout among physicians is a consequence of chronic occupational stresses and emotionally intense work demands. However, much of the evidence exploring burnout is derived from urban settings and may not reflect the work and social contexts of physicians in Indigenous communities or in rural and resource-constrained areas. We sought to characterize health system factors that influence burnout among physicians practicing in the three northern territories of Canada. Methods We conducted a mixed-methods study that included an online survey and qualitative interviews with physicians practicing in Nunavut, Northwest Territories, or Yukon in 2019. The survey adapted content from the Maslach Burnout Inventory. Results were analyzed with logistic regression to assess the association between health system factors and burnout. We conducted in-depth interviews with 14 physicians. Qualitative data was coded and analyzed for themes using the ATLAS.ti software. Results Thirty-nine percent of survey respondents (n = 22/57) showed features associated with burnout. Factors associated with burnout included use of electronic medical records (β = − 0.7, p < .05), inadequate financial remuneration (β = − 1.0, p < .05), and cross-cultural issues (β = − 1.1, p < .05). Qualitative analysis further identified physician perceptions of lack of influence over health system policies, systemic failures in cultural safety, discontinuity of care, administrative burden, and physician turnover as important drivers of burnout. Conclusions Physicians practicing in northern regions in Canada experience stress and burnout related to health system factors and cross-cultural issues. The relationship between cross-cultural issues and burnout has not previously been reported. This work may have implications for physician wellbeing and workforce attrition in other resource-constrained or culturally diverse clinical settings.

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