Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

A stereoscopic study of the mouthparts of the marine isopod, Cirolana bovina (Isopoda: Flabellifera)

The three-dimensional study of the mouthparts of the isopod crustacean Cirolana bovina is carried out for specimens collected from the Mediterranean Sea, Alexandria, Egypt, to reveal their morphology and related cuticular microstructures, especially setal types. The mouthparts consist of a labrum, paragnaths, paired mandibles, maxillules, maxillae and maxillipeds. The labrum and the paragnaths are the least developed but peculiarly the mandibles are asymmetrical, large, stout and highly modified. The possible functions of the mouthparts, especially in feeding are discussed in light of their structure. KEY WORDS: Crustacea, isopods, SEM, mouthparts, cuticular microstructures. Egyptian Journal of Biology Vol.3(2) 2001: 20-2

Comparative Study between Traditional and Nano Calcium Phosphate Fertilizers on Growth and Production of Snap Bean (<i>Phaseolus vulgaris</i> L.) Plants

Recently, nanofertilizers are being tested as a new technology, either for soil or foliar applications, to improve food production and with a reduced environmental impact. Nano calcium phosphate (NCaP) was successfully synthesized, characterized and applied in this study. A pot experiment was carried out in two successive seasons in 2016 and 2017 on (Phaseolus vulgaris L.) plants to obtain the best phosphorus treatments. The results were applied in a field experiment during the 2018–2019 season. Single superphosphate (SSP) at 30 and 60 kg P2O5 fed−1 and NCaP at 10%, 20% and 30% from the recommended dose were applied to the soil. Foliar application involved both monoammonium phosphate (MAP) at one rate of 2.5 g L−1 and NCaP at 5% and 10% from the MAP rate. The results of all experiments showed that NCaP significantly increased the shoot and root dry weights, the nutrient content in the shoot and root, the yield components, the nutrient concentration and crude protein percentage in pods of the snap bean plants compared with traditional P. The greatest increase was obtained from a 20% NCaP soil application in combination with a 5% NCaP foliar application. The present study recommends using NCaP as an alternative source of P to mitigate the negative effects of traditional sources

Effect of growth seasons and nitrogen fertilization on the growth, yield and nitrate accumulation of lettuce (Lactuca sativa L.) plants

In modern agriculture, the nitrate accumulation in vegetables has become a serious threat to human health. That caused by an imbalance between nitrate absorption and assimilation in plants. Nitrogen fertilization and light intensity are the main factors affected nitrate accumulation. Therefore, a pot experiment was conducted during two successive summer and winter seasons of 2019/20 at the greenhouse of Fac. Agric., Cairo Univ., Giza, Egypt, on lettuce (Lactuca sativa L. var. longifolia Lam) plants to investigate the effect of growth seasons (summer and winter), different rates (0, 60, 90 and 120 Kg N fed-1) and sources (CO (NH2)2, NH4NO3 and (NH4)2SO4) of nitrogen fertilizers on lettuce growth and nitrate concentrations. The results showed that fresh and dry weight, yield and nutrient contents of lettuce plants increased gradually according to increasing dose of nitrogen, up to 90 Kg N fed-1 and the magnitude of increase, according to different N fertilizers used , was in the following order: CO (NH2)2 &gt; NH4NO3 &gt; (NH4)2SO4. The accumulation of nitrate was higher in winter compared to summer season for both inner and outer leaves.&nbsp

Zinc Oxide Nanoparticles and Fe-Modified Activated Carbon Affecting the In Vitro Growth of Date Palm Plantlets cv. Medjool

The survival and growth of in vitro plantlets are still problematic for the date palm; thus, the application of nanotechnology may provide date palm plantlets that develop faster with enhanced growth and biochemical parameters. Moreover, the usage of Fe-modified activated carbon (Fe-AC) prepared from date palm pits instead of activated charcoal (AC) in tissue culture media during the current investigation can be considered an innovative approach. Furthermore, the effect of zinc oxide nanoparticles (ZnO-NPs) and bulk particles (ZnO-BPs) on the rooting and growth of date palm plantlets and on some physiological indices was also investigated. X-ray diffraction, dynamic light scattering, scanning electron microscopy, and transmission electron microscopy were used to characterize Fe-AC and ZnO-NPs. As detected from the characterization, the particle size was 720 nm for Fe-AC and 60 nm for ZnO-NPs. The obtained results indicated that AC significantly enhanced plantlet growth, plantlet height, number of leaves/plantlet, root length, number of roots/plantlet, and the concentrations of IAA, chlorophyll a and chlorophyll b compared with Fe-AC. On the other hand, sugars and phenols concentrations, and POD and PAL activities were highly increased with Fe-AC. There was no significant difference in terms of plant fresh weight (FW), leaf length, leaf width, protein, amino acids, and carotenoids. ZnO nanoparticles significantly improved plant height, leaf length, leaf width, root length, and the concentrations of IAA, chlorophylls a and b, and carotenoids; in contrast, the bulk form increased roots/plantlet, amino acids, and total sugars. Supplying the MS medium with combinations of ZnO-NPs or ZnO-BPs and AC or Fe-AC significantly increased all growth and physiological parameters. Plant height, leaf length, leaf width, root length, and the concentrations of IAA, protein, and chlorophylls a and b significantly increased when ZnO-NPs were combined with AC. Amino acids, total sugars, carotenoids, and phenols concentrations and the activities of POD and PAL increased when ZnO-BPs and Fe-AC were added together

Morpho-Anatomical and Biochemical Characterization of Embryogenic and Degenerative Embryogenic Calli of Phoenix dactylifera L.

The study of morpho-anatomical aspects, metabolic changes of proteins, antioxidant substances, as well as phenolic compounds in embryogenic callus (EC) and degenerative embryogenic callus (DEC) was the aim of the present investigation. Ability to form somatic embryos (SEs) was associated with the softness of the EC, which exhibited a white or creamy color and was composed of isodiametric cells containing dense cytoplasm, conspicuous nuclei and minimal vacuoles with observed mitotic activity. Furthermore, protein, reduced glutathione (GSH) and ascorbic acid (ASC) concentrations and the ratio between ASC and dehydroascorborbic acid (DHA) were increased significantly in the EC in comparison to the DEC. In addition, the phenolic extract of the EC was proved to have higher scavenging activity than the extract from the DEC. A loss of embryogenic competence in the DEC was correlated with the presence of more rigid clumps and such calli had a yellowish to brown color and no cell division could be observed in the cells of such aggregates as the cells had large vacuoles and they have very thick walls. Moreover, these morphological and anatomical observations of the DEC were accompanied by accumulations of the oxidized form of ascorbic acid (DHA), H2O2, total soluble phenolic compounds and overaccumulation of naringenin. Alternations in cellular metabolism can affect and regulate the morphogenesis of somatic embryos

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)