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

Wastewater treatment in horizontal subsurface flow constructed wetlands using different media (setup stage)

Wastewater treatment through horizontal subsurface flow (HSSF) constructed wetlands (CWs) using three different treatment media (gravel, pieces of plastic pipes, and shredded tire rubber chips) were investigated in Samaha village, Dakahliya, Egypt. The study focused on the wetland setup stage during the first months of its operation (setup stage). In this stage media porosity, bacterial biofilm, and plant roots growth were in progress and it was prior to the operational steady state stage. Objectives of this paper are to study the change in media porosity of HSSF wetland cells in order to estimate duration of wetland setup stage, and to evaluate the use of different bed media on biological oxygen demand (BOD), chemical oxygen demand (COD) and total suspended solids (TSS) treatment. The results showed that after 180 days of operation, the wetland cells had reached steady porosity and had started stable treatment. Also performance of plastic media bed in pollutants reduction was better than gravel and rubber beds and gravel media was in advanced than rubber media