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

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Etude du comportement physico-chimique des hydro-retenteurs polyacrylamides nouvelles. Nouvelles methodes d'utilisation et de depollution des eaux

SIGLEAvailable from INIST (FR), Document Supply Service, under shelf-number : T 81702 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

Élimination du phosphore, de l'ammonium et des nitrates par alternance de phases dans des réacteurs biologiques

This article concern the elimination of orthophosphates, ammonia and nitrates in waste water. A sample of activated sludge has been taked from biological reactor of a classical plant of waste water treatment to sow two tanks of our installation. A nutritious solution enriched in substrates (PO43- and NH4+) has been prepared to be introduced in the tanks. The volume of the biological reactor has been optimised by reducing the de-nitrification time in favour of the nitrification time. The alternation of phasis aerated and non-aerated into a pH zone essentially basic (near by 9) had been respected. After acclimatization of the microorganisms and their multiplication during this stage, the cultures had been injected continuously by the prepared solution. The results has showed: a totally transformation of ammonia, an elimination of 99% of orthophosphates; the speed of dephosphatation has rised 83,40 mgP.g-1VMS.d-1, the speed of de-nitrification has rised 379 mg N-NO3-.g-1VMS.d-1. The interest of this study is to deal with the orthophosphates, ammonia and nitrates discharges in a small- sized tanks.Cet article concerne l'élimination des orthophosphates, de l'ammonium et des nitrates des eaux usées. À partir des boues activées, prélevées du bassin biologique d'une station d'épuration classique, des cultures en batch puis en continu ont été menées. Une solution nutritive préparée et enrichie en substrats (PO43- et NH4+) a été injectée dans les cuves contenant les boues. Le volume du réacteur biologique a été optimisé par la réduction du temps de dénitrification au bénéfice du temps de nitrification. L'alternance des phases, aérobie et anaérobie dans une zone de pH basique (proche de 9) a été respectée. Après acclimatation des microorganismes et leur multiplication au cours de cette étape, les cultures ont été conduites avec injection en continu du milieu nutritif préparé. Les résultats ont montré : une transformation totale de l'ammonium, un rendement d'élimination des orthophosphates de 99 % ; les vitesses de déphosphatation ont atteint 83,40 mg P.g-1MVS.j-1, les vitesses de dénitrification ont atteint 379 mg N-NO3-.g-1MVS.j-1. L'intérêt de cette étude est de satisfaire les rejets en orthophosphates, ammonium et nitrates avec des bassins d'aération de volume réduit

Etude des paramètres physico-chimiques de la biométhanisation des ordures ménagères

The methanization of the domestic wastes constitutes a treatment and a technical valorization with several advantages: reduction of environmental harmful effects, production of biogas and obtaining an organic fertilizer matter. The sequence of the methanization has been realized with a fermentation reactor containing selected and ground household refuse. The main purpose of this work was the control of various parameters for the starting of the fermentation pilot in a discontinuous way and the methanization procedure, also to verify feasibility of scaling up at industrial level. Our results constitute a first step towards other experimentations to be performed in this field. A mesophilic range of temperature, a neutral acidity value, convenient stiring, a well-balanced VFA/CAR ratio are the major parameters to be controlled, in addition to the good selection and grinding of the domestic wastes. Otherwise a deficient stiring system and an excessive VFA production contribute in addition to the heterogeneous nature of wastes to the inhibition of methanogenesis process. The obtained compost is mature, humid and rich in organic matter. After valorization, it could be used as amendment for deficient soils in organic matter.La méthanisation des ordures ménagères est une technique de valorisation qui présente plusieurs avantages : réduction des nuisances environnementales, production de biogaz et obtention d’un compost valorisable. Le procédé de méthanisation a été appliqué pour traiter des ordures ménagères triées et broyées. Les principaux objectifs de ce travail étaient de fixer les différentes conditions pour le démarrage du pilote de fermentation en discontinu, de suivre le procédé de méthanisation afin de vérifier sa faisabilité à l’échelle industrielle. Une température à plage mésophile, un pH neutre, un brassage convenable, un rapport AGV/TAC bien équilibré sont les principaux paramètres indispensables pour le contrôle du procédé de méthanisation. Par contre, une production excessive des AGV, une hétérogénéité des ordures et un brassage déficient contribuent à l’inhibition du processus de la méthanogènes. Le digestat obtenu est humide, mature et riche en matières organiques. Après valorisation, il peut être utilisé comme amendement aux sols appauvris en matières organiques

Etude des échanges d’azote minéral entre les gels de polyacrylamide et une solution minérale nutritive dans un réacteur biologique de nitrification

We have conducted a study concerning the nitrification in a three phases biological reactor. First, a selection of the nitrifying bacteria was done by using an activated sludge taken from the biological and aerated tank at the waste water treatment plant. Then the nitrifying biomass selected was fixed on a granulated polyacrylamid gel to convert ammonia into nitrate. The chemical analyses show that 98 to 99 per cent and per day of ammonia were converted into nitrate. The immobilisation media absorbs a large quantity of ammonia and nitrates in the reactor. Substrate exchanges and other inorganic elements are continuous between solution and gel. In this way, when ammonia concentration decreases in the solution, a part of substrate absorbed by the media is released in solution until totally ammonia exhausting from reactor.Nous avons étudié la nitrification par voie biologique dans un réacteur triphasique. Au départ, nous avons effectué une sélection des bactéries nitrifiantes à partir d’une solution de boues activées. Cette dernière a été prélevée du bassin d’aération d’une station d’épuration des eaux usées. Ensuite, les bactéries ont été fixées sur un support de polyacrylamide afin de nitrifier des solutions minérales riches en ammonium. Le suivi analytique de l’élimination de l’ammonium, des nitrites et de la production des nitrates montre un rendement de 98 à 99 % par jour. Les supports retiennent une quantité importante d’azote minéral présent dans le réacteur. Les échanges de substrats et d’autres éléments minéraux sont permanents entre le gel et la solution. Ainsi, lorsque la concentration en azote ammoniacal diminue dans le milieu de culture, une partie du substrat retenu par le support sera libérée dans la phase liquide, et ce jusqu’à épuisement de l’ammonium du réacteur

Etude des caractéristiques physico-chimiques et contribution à la valorisation agronomique du compost des ordures ménagères

La production des déchets urbains est une source majeure de pollution qui pose des problèmes au niveau environnemental et sanitaire.Les ordures ménagères peuvent être traitées par compostage et le refus éliminé, soit par incinération soit par recyclage des co-produits. La fermentation aérobie des ordures ménagères entraine l'obtention d'un amendement organique indispensable à l'amélioration de la qualité des sols. L'objectif de cette étude est de suivre la qualité du compost produit. Le suivi des paramètres de fonctionnement au cours des étapes de fermentation et de la maturation permet une estimation de sa valeur agronomique et de la contamination éventuelle des plantes par les métaux lourds.L'évaluation de l'impact du compost en agriculture a été effectuée sur deux variétés de cultures et avec deux types de sols agricoles qui ont été mélanges à des proportions variables du compost.Le produit obtenu est classé comme un compost « moyen ». De même, le taux de 25 % du compost urbain est le plus bénéfique et n'engendre pas d'effets néfastes et toxiques pour la culture. L'utilisation d'une dose dépassant cette valeur peut ralentir le développement des végétaux et augmenter la teneur en métaux lourds dans les feuilles et les fruits