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

Dexmedetomidine- or Clonidine-Based Sedation Compared With Propofol in Critically Ill Patients

Importance Whether α2-adrenergic receptor agonist–based sedation, compared with propofol-based sedation, reduces time to extubation in patients receiving mechanical ventilation in the intensive care unit (ICU) is uncertain. Objective To evaluate whether dexmedetomidine- or clonidine-based sedation reduces duration of mechanical ventilation compared with propofol-based sedation (usual care). Design, Setting, and Participants Pragmatic, open-label randomized clinical trial conducted at 41 ICUs in the UK including adults who were within 48 hours of starting mechanical ventilation, were receiving propofol plus an opioid for sedation and analgesia, and were expected to require mechanical ventilation for 48 hours or longer. The median time from intubation to randomization was 21.0 (IQR, 13.2-31.3) hours. Recruitment occurred from December 2018 to October 2023; the last follow-up occurred on December 10, 2023. Interventions The bedside algorithms used targeted a Richmond Agitation-Sedation Scale score of −2 to 1 (unless clinicians requested deeper sedation). The algorithms supported uptitration in the dexmedetomidine- and clonidine-based sedation intervention groups and supported downtitration for propofol-based sedation followed by sedation primarily with the allocated sedation (dexmedetomidine or clonidine). If required, supplemental use of propofol was permitted. Main Outcomes and Measures The primary outcome was time from randomization to successful extubation. The secondary outcomes included mortality, sedation quality, rates of delirium, and cardiovascular adverse events. Results Among the 1404 patients in the analysis population (mean age, 59.2 [SD, 14.9] years; 901 [64%] were male; and the mean APACHE II score was 20.3 [SD, 8.2]), the subdistribution hazard ratio (HR) for time to successful extubation was 1.09 (95% CI, 0.96-1.25; P = .20) for dexmedetomidine (n = 457) vs propofol (n = 471) and was 1.05 (95% CI, 0.95-1.17; P = .34) for clonidine (n = 476) vs propofol (n = 471). The median time from randomization to successful extubation was 136 (95% CI, 117-150) hours for dexmedetomidine, 146 (95% CI, 124-168) hours for clonidine, and 162 (95% CI, 136-170) hours for propofol. In the predefined subgroup analyses, there were no interactions with age, sepsis status, median Sequential Organ Failure Assessment score, or median delirium risk score. Among the secondary outcomes, agitation occurred at a higher rate with dexmedetomidine vs propofol (risk ratio [RR], 1.54 [95% CI, 1.21-1.97]) and with clonidine vs propofol (RR, 1.55 [95% CI, 1.22-1.97]). Compared with propofol, the rates of severe bradycardia (heart rate <50/min) were higher with dexmedetomidine (RR, 1.62 [95% CI, 1.36-1.93]) and clonidine (RR, 1.58 [95% CI, 1.33-1.88]). Compared with propofol, mortality was similar over 180 days for dexmedetomidine (HR, 0.98 [95% CI, 0.77-1.24]) and clonidine (HR, 1.04 [95% CI, 0.82-1.31]). Conclusions and Relevance In critically ill patients, neither dexmedetomidine nor clonidine was superior to propofol in reducing time to successful extubation. Trial Registration ClinicalTrials.gov Identifier: NCT0365383

Dynamic Mass of a Reaction Wheel Including Gyroscopic Effects: an Experimental Approach

In recent years, driven by the increasingly stringent stability requirements imposed by some satellites’ payloads (e.g., the new generation of optical instruments), the issue of accurate onboard spacecraft microvibration modeling has attracted significant interest from engineers and scientists. This paper investigates the microvibration-induced phenomenon on a cantilever-configured reaction wheel assembly including sub- and higher harmonic amplifications due to modal resonances and broadband noise. A mathematical model of the reaction wheel assembly is developed and validated against experimental test results. The model is capable of representing each configuration in which the reaction wheel assembly will operate, whether it is hard mounted on a dynamometric platform or suspended free–free. The outcomes of this analysis are used to establish a novel methodology to retrieve the dynamic mass of the reaction wheel assembly in its operative range of speeds. An alternative measurement procedure has been developed for this purpose, showing to produce good estimates over a wide range of frequencies using a less complex test campaign compared with typical dynamic mass setups. Furthermore, the gyroscopic effect influence in the reaction wheel assembly response is thoroughly examined both analytically and experimentally. Finally, to what extent the noise affects the convergence of the novel approach is investigated

Experimental and numerical investigation of coupled microvibration dynamics for satellite reaction wheels

Microvibrations of a satellite reaction wheel assembly are commonly analysed in either hard-mounted or coupled boundary conditions, though coupled wheel-to-structure disturbance models are more representative of the real environment in which the wheel operates. This article investigates the coupled microvibration dynamics of a cantilever configured reaction wheel assembly mounted on either a stiff or flexible platform. Here a method is presented to cope with modern project necessities: (i) need of a model which gives accurate estimates covering a wide frequency range; (ii) reduce the personnel and time costs derived from the test campaign, (iii) reduce the computational effort without affecting the quality of the results. The method involves measurements of the disturbances induced by the reaction wheel assembly in a hard-mounted configuration and of the frequency and speed dependent dynamic mass of the reaction wheel. In addition, it corrects the approximation due to missing speed dependent dynamic mass in conventional reaction wheel assembly microvibration analysis. The former was evaluated experimentally using a previously designed and validated platform. The latter, on the other hand, was estimated analytically using a finite element model of the wheel assembly. Finally, the validation of the coupled wheel-structure disturbance model is presented, giving indication of the level of accuracy that can be achieved with this type of analyses

Dynamic Mass of a Reaction Wheel Including Gyroscopic Effects: an Experimental Approach

In recent years, driven by the increasingly stringent stability requirements imposed by some satellites’ payloads (e.g., the new generation of optical instruments), the issue of accurate onboard spacecraft microvibration modeling has attracted significant interest from engineers and scientists. This paper investigates the microvibration-induced phenomenon on a cantilever-configured reaction wheel assembly including sub- and higher harmonic amplifications due to modal resonances and broadband noise. A mathematical model of the reaction wheel assembly is developed and validated against experimental test results. The model is capable of representing each configuration in which the reaction wheel assembly will operate, whether it is hard mounted on a dynamometric platform or suspended free–free. The outcomes of this analysis are used to establish a novel methodology to retrieve the dynamic mass of the reaction wheel assembly in its operative range of speeds. An alternative measurement procedure has been developed for this purpose, showing to produce good estimates over a wide range of frequencies using a less complex test campaign compared with typical dynamic mass setups. Furthermore, the gyroscopic effect influence in the reaction wheel assembly response is thoroughly examined both analytically and experimentally. Finally, to what extent the noise affects the convergence of the novel approach is investigated

Electrochemistry and surface chemistry of stainless steels in alkaline media simulating concrete pore solutions

Despite the increased use of stainless steel for concrete reinforcement in harsh chloride environments, comparatively little is known about the surface chemistry of these materials in alkaline media simulating concrete pore solutions. This work is concerned with a combined electrochemical and XPS surface analytical investigation on austenitic, ferritic and duplex stainless steels in simple NaOH and more complex alkaline concrete pore solutions. The results show that the passive films on these materials change with immersion time, the ferritic and duplex stainless steels becoming enriched in chromium oxy-hydroxide, the austenitic steel strongly enriched in nickel hydroxide. The composition of the metal layer beneath the surface film is strongly enriched in nickel and depleted in chromium and iron. The results are discussed with respect to the relation between the Fe(II) content in the films and the open circuit potential (OCP) during exposure, the film growth mechanism and localized corrosion resistance