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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

<span style="font-size:12.0pt;line-height: 115%;font-family:"Times New Roman","serif";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-IN;mso-fareast-language:EN-IN;mso-bidi-language:HI" lang="EN-IN">Optical studies of gamma-irradiated SmF₃ doped Li₂O-B₂O₃-SiO₂ glasses</span>

714-721The effect of the gamma-radiation doses between 0.001 and 11.4 kGy in SmF3-lithium-boro-silicate glasses is characterised by the presence of two pronounced optical peaks, due to radiolytic activated relaxation of structural defects, typical of amorphous materials. The intensities of the two bands at (400 and 560 nm) were measured .Visible absorption in the range 200-900 nm and the decay bands over six months were studies. The data obtained indicate that the self-quenching of Sm+3 irradiated in lithium-boro-silicate glass matrix is due to forbidden transitions involving the 4f levels which is allowed by electric dipole effects. The results obtained indicated that the sensitivity of lithium-boro-silicate glasses to low doses of γ- rays increased with the introduction of samarium fluoride and more predominantly with increasing samarium content. The sensitivity reached a maximum at the absorption band at 400 nm

Chemical resistance of some irradiated ceramic-glazes

514-524The effect of neutrons irradiation on the chemical durability of some ceramic-glazes with different compositions has been investigated with particular attention to the change in the corrosion rate. Different factors have been studied such as glaze composition, irradiation dose, concentration of the leaching solution, immersion time and temperature of leaching solution. It was found that zircon improved the chemical durability. Corrosion rate increased with increasing concentration of immersion solution up to 2N HNO3 then decreased, also it increased with increasing immersion time and raising the temperature of leaching solution. The amount of the silica released in solution showed a maximum weight loss percent up to 2N HNO3, and then decreased dramatically with increasing the concentration of the tested solution. The corrosion results have been explained in relation to the hydration, diffusion and selective dissolution. The density increases with successive increase of zirconium oxide content reaching the highest value of 2.59 g/cm3. The induced defects obtained on irradiating a glaze, either in the surface or in the bulk, have been assumed to result from neutron irradiation which decreases both the chemical durability and the density

Collective Optical, FTIR, and Photoluminescence Spectra of CeO2 and/or Sm2O3-Doped Na2O–ZnO–P2O5 Glasses

Glasses with the Na2O–ZnO–P2O5 composition and doped with single CeO2, Sm2O3, or mixed dopants were melted and studied. Collective optical, photoluminescence, and FT-infrared spectral studies were carried out. CeO2-doped glasses show two extra UV absorption bands due to Ce4+ and Ce3+ ions while Sm2O3-doped samples reveal pronounced peaks collected into two segments from 367 to 472 nm and from 950 to 1623 nm which are characteristic of absorption from Sm3+ ions. The mixed dopants glasses show combined UV-visible–near-IR absorption peaks due to cerium (Ce4+, Ce3+) ions and samarium (Sm3+) ions. The photoluminescence spectra (PL) of the single CeO2-doped and Sm2O3-doped glasses and even the mixed dopant sample reveal luminescence spectra after excitation which are characteristic of the rare-earth ions. The intensities for both excited or emitted peaks are found to increase with the increase of the rare-earth percent. FTIR spectra of the glasses show pronounced vibrational peaks related to phosphate groups (Q2 and Q3 units) in accordance with the P2O5 percent (70 mol %)

A Comparison of Modifications Induced by Heat-Treatment and γ-Irradiation in Spectroscopic Properties of Silica-Gel Thin Film Doped with Nd2O3

Thin SiO2 silica-gel film doped with 1mol.% Nd3+ ions has been synthesized using tetraethyl-orthosilicate (TEOS) and neodymium nitrate as precursor sources of silica and neodymium oxides. The amorphous nature of gel glasses has been confirmed by XRD spectra. XRD investigation shows that both low (500oC) and high (1150oC) heat-treated samples to be amorphous indicating that the Nd ions are incorporated in the SiO2 network. Both temperature and gamma-radiation-dependent spectroscopic properties of Nd3+ ions in silicate glass were studied. As the temperature increases, the optical absorption (O.A.) intensity of Nd2+ increases sharply. However transmission% (T%)nbsp decreases sharply except at maximal temperature (1150oC) where it is completely increased. Optical absorption spectra (UV-vis) of the samples before and after gamma- irradiation show generation of new broad band below 500 nm (390ndash458nm) along with dips in the spectrum at the location of main Nd3+ absorption lines at maximal heat-treatment temperature (1150oC). This is attributed to the generation of different types of defects in the glass matrix along with possibility of change in the valence state of Nd3+ to Nd2+. The behavior of both O.A. and T% spectra of the irradiated samples designates a strong dependence with gamma radiation doses, where the magnetic dipole transition 5D0rarr7F1 of the Nd3+ ions presents huge defects for irradiation doses up to 18 kGy. FTIR absorption spectra of these glasses are found to be dominated mainly by the characteristics silicate groups and water (OH) present in the glass network. The effects of temperature on IR absorption are observed in the form of bond breaking and possible re-arrangement of bonding. However, gamma- irradiation produces minor effect on the IR spectra which can be related to the shielding behavior of the glass. The generation and bleaching of irradiated sol gel glass were found to permit the creation and reduction of the larger part of Nd3+ or Nd2+ ions respectively in the glass. This study also shows the usefulness of this sol-gel glass as yes or no dischargeable irradiation detector, due to the remarkable color change after irradiation, which persists for a long time (up to 20 days)

Combined x-ray diffraction and absorption study of crystalline vanadium-doped lithium disilicate

Structure of vanadium-doped lithium disilicate, $Li_{2}Si_{2}O_{5}$ (Ccc2 space group) is studied. This crystalline phase is obtained by annealing of the doped lithium disilicate glass for 4 h at 550°C. X-ray diffraction and X-ray absorption near-edge structure analysis indicate location of vanadium atoms at Si sites. the lattice parameters are found to increase isotropically with increasing vanadium content. the valency of vanadium ions is discussed on the basis of X-ray absorption near-edge structure results