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

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Performance of shariah-compliant firms and non-shariah-compliant firms in the MENA region: Which is better?

Purpose This paper aims to document the relative performance of non-financial shariah-compliant firms and non-financial non-shariah-compliant firms in the MENA (Morocco, Egypt, Saudi Arabia, United Arab Emirates, Jordan, Kuwait and Bahrain) region during the period between 2005 and 2009. Design/methodology/approach This paper uses pooled ordinary least squares regression analysis to document the effect of shariah compliance on stock price performance in the MENA region on a sample of non-financial firms that consists of shariah- and non-shariah-compliant firms. Findings Using market-adjusted returns as a proxy for performance, this paper shows that shariah-compliant firms underperform non-shariah-compliant firms. The results also show that underperformance of shariah-compliant firms holds in the civil law and in the common law countries. Interestingly, this paper also shows that difference between the performance of shariah-and non-shariah-compliant firms disappears during the crisis period. Research limitations/implications This paper argues that the characteristics of shariah-compliant firms are such that these firms are at a disadvantage relative to their non-shariah-compliant counterparts. For example, high leverage of their counterpart firms can act as a disciplining mechanism and positively affect performance of these firms. Similarly, high account receivables and high cash allow non-shariah-compliant firms to make more effective business networks than shariah-compliant firms and fund large capital expenditures. Consequently, shariah-compliant firms underperform non-shariah-compliant firms. This study’s results, however, should be read with caution, as they are mainly based upon the performance of large volume, statistical significance, sampling errors and possible labeling miss-specification. Further research on this topic with different research methodology is essential. Originality/value This paper takes a financial view rather than religious view while highlighting the impact of shariah characteristics on firm performance. </jats:sec

Influence of TiO2 and ZrO2 Nanoparticles on Adhesive Bond Strength and Viscosity of Dentin Polymer: A Physical and Chemical Evaluation

The present study aimed to formulate an experimental adhesive (EA) and reinforce it with 5 wt.% titanium dioxide (TiO2) or zirconium oxide (ZrO2) to yield 5% TiO2 and 5% ZrO2 adhesives, respectively, and then analyze the impact of this reinforcement on various mechanical properties of the adhesives. The EA contained a blend of monomers such as bisphenol A glycol dimethacrylate (BisGMA), triethylene glycol dimethacrylate (TEGDMA), 2-hydroxyethyl methacrylate (HEMA), and ethyl 4-dimethylamino benzoate and camphorquinone. The EA included ethyl 4-dimethylamino benzoate and camphorquinone photo-initiators, and diphenyliodonium hexafluorophosphate (DPIHP) was also included to act as an electron initiator. The TiO2 and ZrO2 nanoparticles were incorporated into the EA post-synthesis. To characterize the filler nanoparticles, scanning electron microscopy (SEM) and line-energy dispersive X-ray (EDX) spectroscopy were performed. The adhesives were characterized by analyzing their rheological properties, shear-bond strength (SBS), and interfacial failure types. Further, the resin–dentin interface was also analyzed via SEM. The TiO2 nanoparticles were spherically shaped on the SEM micrographs, while the ZrO2 nanoparticles were seen as non-uniformly shaped agglomerates. The EDX mapping demonstrated the presence of Ti and oxygen for TiO2 and Zr and oxygen for the ZrO2 nanoparticles. Both 5% TiO2 and 5% ZrO2 adhesives revealed decreased viscosity as compared with the EA. The 5% TiO2 adhesive demonstrated higher SBS values for both non-thermocycled (NTC) and thermocycled samples (NTC: 25.35 ± 1.53, TC: 23.89 ± 1.95 MPa), followed by the 5% ZrO2 adhesive group (NTC: 23.10 ± 2.22, TC: 20.72 ± 1.32 MPa). The bulk of the failures (&gt;70%) were of adhesive type in all groups. The SEM analysis of the resin–dentin interface revealed the development of a hybrid layer and resin tags (of variable depth) for the EA and 5% TiO2 groups. However, for the 5% ZrO2 group, the hybrid layer and resin tag establishment appeared compromised. Reinforcement of the EA with TiO2 or ZrO2 caused an increase in the adhesive’s SBS (with the 5% TiO2 group demonstrating the highest values) in comparison with the EA (without nanoparticles). However, both nanoparticle-containing adhesives revealed decreased viscosity compared with the EA (without nanoparticles). Further studies investigating the impact of diverse filler concentrations on the properties of adhesives are suggested

Surface Properties of Polymer Resins Fabricated with Subtractive and Additive Manufacturing Techniques

This study aimed to compare the surface roughness, hardness, and flexure strength of interim indirect resin restorations fabricated with CAD-CAM (CC), 3D printing (3D), and conventional techniques (CV). Twenty disk (3 mm &times; &Oslash;10 mm) and ten bar specimens (25 &times; 2 &times; 2 mm) were fabricated for the CC, 3D, and CV groups, to be used for surface roughness, micro-hardness, and flexural strength testing using standardized protocol. Three indentations for Vickers micro-hardness (VHN) were performed on each disk and an average was identified for each specimen. Surface micro-roughness (Ra) was calculated in micrometers (&mu;m) using a 3D optical non-contact surface microscope. A three-point bending test with a universal testing machine was utilized for assessing flexural strength. The load was applied at a crosshead speed of 3 mm/min over a distance of 25 mm until fracture. Means and standard deviations were compared using ANOVA and post hoc Tukey&ndash;Kramer tests, and a p-value of &le;0.05 was considered statistically significant. Ra was significantly different among the study groups (p &lt; 0.05). Surface roughness among the CC and CV groups was statistically comparable (p &gt; 0.05). However, 3D showed significantly higher Ra compared to CC and CV samples (p &lt; 0.05). Micro-hardness was significantly higher in 3D samples (p &lt; 0.05) compared to CC and CV specimens. In addition, CC and CV showed comparable micro-hardness (p &gt; 0.05). A significant difference in flexural strength was observed among the study groups (p &lt; 0.05). CC and 3D showed comparable strength outcomes (p &gt; 0.05), although CV specimens showed significantly lower (p &lt; 0.05) strength compared to CC and 3D samples. The 3D-printed provisional restorative resins showed flexural strength and micro-hardness comparable to CAD-CAM fabricated specimens, and surface micro-roughness for printed specimens was considerably higher compared to CAD-CAM and conventional fabrication techniques

Defects oriented hydrothermal synthesis of TiO2 and MnTiO2 nanoparticles as photocatalysts for wastewater treatment and antibacterial applications

Pure and manganese-doped titanium dioxide nanoparticles (MnTiO2-NPs) were synthesized by the defect-oriented hydrothermal approach. The synthesized material was then characterized by X-ray diffraction (XRD), Scanning electron microscopy (SEM), Energy dispersive X-ray spectroscopy (EDX), and UV–visible spectroscopy (UV–Vis). The agar well diffusion method assessed the antibacterial efficiency of TiO2 and MnTiO2-NPs against E. coli and S. aureus. Zone of inhibition (ZOI) formed by pure TiO2 was observed as 12 mm and 11.5 mm against E. coli and S. aureus, while for MnTiO2-NPs it was observed as 19 mm (E. coli) and 21 mm (S. aureus). The concentration of synthesized nanoparticles (10 mg/ml, and 20 mg/ml) was used for antibacterial studies. The efficacy of the pure and MnTiO2-NPs as an active photocatalyst for the degradation of methylene blue (MB) dye was also assessed using a UV light. It was observed that the photodegradation efficiency of 1 g of MnTiO2-NPs was higher than the same amount of pure TiO2. The results suggest that the photocatalyst concentration directly impacts the photodegradation of MB dye. The pH value was found to influence the photodegradation of MB dye at higher pH values. Based on the obtained results, MnTiO2-NPs were observed as a promising agent for microbial resistance and water remediation

Eight Genome Sequences of Cluster BE1 Phages That Infect Streptomyces Species

This article reports eight newly isolated Streptomyces bacteriophages recovered using either direct plating or enrichment on three Streptomyces hosts