Did the COVID-19 pandemic affect levels of burnout, anxiety and depression among doctors and nurses in Bangladesh? A cross-sectional survey study

Introduction COVID-19 has caused severe disruption to clinical services in Bangladesh but the extent of this, and the impact on healthcare professionals is unclear. We aimed to assess the perceived levels of anxiety, depression and burnout among doctors and nurses during COVID-19 pandemic.Methods We undertook an online survey using RedCap, directed at doctors and nurses across four institutions in Bangladesh (The Sheikh Russel Gastro Liver Institute & Hospital (SRNGIH), Dhaka Medical College Hospital (DMCH), Mugda Medical College Hospital (MMCH) and M Abdur Rahim Medical College (MARMC) Hospital). We collected information on demographics, awareness of well-being services, COVID-19-related workload, as well as anxiety, depression and burnout using two validated questionnaires: the Hospital Anxiety and Depression Scale (HADS) and the Maslach Burnout Inventory (MBI).Results Of the 3000 participants approached, we received responses from 2705 (90.2%). There was a statistically significant difference in anxiety, depression and burnout scores across institutions (p<0.01). Anxiety, depression and burnout scores were statistically worse in COVID-19 active staff compared with those not working on COVID-19 activities (p<0.01 for HADS anxiety and depression and MBI emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA)). Over half of the participants exhibited some level of anxiety (SRNGIH: 52.2%; DMCH: 53.9%; MMCH: 61.3%; MARMC: 68%) with a high proportion experiencing depression (SRNGIH: 39.5%; DMCH: 38.7%; MMCH: 53.7%; MARMC: 41.1%). Although mean burnout scores were within the normal range for each institution, a high proportion of staff (almost 20% in some instances) were shown to be classified as experiencing burnout by their EE, DP and PA scores.Conclusion We identified a high prevalence of perceived anxiety, depression and burnout among doctors and nurses during the COVID-19 pandemic. This was worse in staff engaged in COVID-19-related activities. These findings could help healthcare organisations to plan for future similar events

Phase II multicentre, double-blind, randomised trial of ustekinumab in adolescents with new-onset type 1 diabetes (USTEK1D): trial protocol

Introduction Most individuals newly diagnosed with type 1 diabetes (T1D) have 10%–20% of beta-cell function remaining at the time of diagnosis. Preservation of residual beta-cell function at diagnosis may improve glycaemic control and reduce longer-term complications.Immunotherapy has the potential to preserve endogenous beta-cell function and thereby improve metabolic control even in poorly compliant individuals. We propose to test ustekinumab (STELARA), a targeted and well-tolerated therapy that may halt T-cell and cytokine-mediated destruction of beta-cells in the pancreas at the time of diagnosis.Methods and analysis This is a double-blind phase II study to assess the safety and efficacy of ustekinumab in 72 children and adolescents aged 12–18 with new-onset T1D.Participants should have evidence of residual functioning beta-cells (serum C-peptide level >0.2nmol/L in the mixed-meal tolerance test (MMTT) and be positive for at least one islet autoantibody (GAD, IA-2, ZnT8) to be eligible.Participants will be given ustekinumab/placebo subcutaneously at weeks 0, 4 and 12, 20, 28, 36 and 44 in a dose depending on the body weight and will be followed for 12 months after dose 1.MMTTs will be used to measure the efficacy of ustekinumab for preserving C-peptide area under the curve at week 52 compared with placebo. Secondary objectives include further investigations into the efficacy and safety of ustekinumab, patient and parent questionnaires, alternative methods for measuring insulin production and exploratory mechanistic work

The direct synthesis of hydrogen peroxide from H₂ and O₂ using Pd-Ni/TiO₂ catalysts

The direct synthesis of hydrogen peroxide (H2O2) from molecular H2 and O2 offers an attractive solution to decentralised production compared to the anthraquinone process. Herein we evaluate the performance of a 0.5%Pd-4.5%Ni/TiO2 catalyst in batch and flow reactor systems using water as a solvent at ambient temperature which makes synthesising high H2O2 concentrations challenging. Catalyst activity was observed to be stable to prolonged use in multiple batch experiments or in a flow system, with selectivities towards H2O2 of 97% and 85% respectively. This study was carried out in the absence of halide or acid additives that are typically used to inhibit sequential H2O2 degradation reactions showing that this Pd-Ni catalyst has potential to produce H2O2 selectivel

Tuning graphitic oxide for initiator- and metal-free aerobic epoxidation of linear alkenes

Graphitic oxide has potential as a carbocatalyst for a wide range of reactions. Interest in this material has risen enormously due to it being a precursor to graphene via the chemical oxidation of graphite. Despite some studies suggesting that the chosen method of graphite oxidation can influence the physical properties of the graphitic oxide, the preparation method and extent of oxidation remain unresolved for catalytic applications. Here we show that tuning the graphitic oxide surface can be achieved by varying the amount and type of oxidant. The resulting materials differ in level of oxidation, surface oxygen content and functionality. Most importantly, we show that these graphitic oxide materials are active as unique carbocatalysts for low-temperature aerobic epoxidation of linear alkenes in the absence of initiator or metal. An optimum level of oxidation is necessary and materials produced via conventional permanganate-based methods are far from optimal

The effect of sodium species on methanol synthesis and water-gas shift Cu/ZnO catalysts: utilising high purity zincian georgeite

The effect of sodium species on the physical and catalytic properties of Cu/ZnO catalysts derived from zincian georgeite has been investigated. Catalysts prepared with <100 ppm to 2.1 wt% Na+, using a supercritical CO2 antisolvent technique, were characterised and tested for the low temperature water–gas shift reaction and also CO2 hydrogenation to methanol. It was found that zincian georgeite catalyst precursor stability was dependent on the Na+ concentration, with the 2.1 wt% Na+-containing sample uncontrollably ageing to malachite and sodium zinc carbonate. Samples with lower Na+ contents (<100–2500 ppm) remained as the amorphous zincian georgeite phase, which on calcination and reduction resulted in similar CuO/Cu particle sizes and Cu surface areas. The aged 2.1 wt% Na+ containing sample, after calcination and reduction, was found to comprise of larger CuO crystallites and a lower Cu surface area. However, calcination of the high Na+ sample immediately after precipitation (before ageing) resulted in a comparable CuO/Cu particle size to the lower (<100–2500 ppm) Na+ containing samples, but with a lower Cu surface area, which indicates that Na+ species block Cu sites. Activity of the catalysts for the water–gas shift reaction and methanol yields in the methanol synthesis reaction correlated with Na+ content, suggesting that Na+ directly poisons the catalyst. In situ XRD analysis showed that the ZnO crystallite size and consequently Cu crystallite size increased dramatically in the presence of water in a syn-gas reaction mixture, showing that stabilisation of nanocrystalline ZnO is required. Sodium species have a moderate effect on ZnO and Cu crystallite growth rate, with lower Na+ content resulting in slightly reduced rates of growth under reaction conditions

Gas phase stabiliser-free production of hydrogen peroxide using supported gold-palladium catalysts

Hydrogen peroxide synthesis from hydrogen and oxygen in the gas phase is postulated to be a key reaction step in the gas phase epoxidation of propene using gold–titanium silicate catalysts. During this process H2O2 is consumed in a secondary step to oxidise an organic molecule so is typically not observed as a reaction product. We demonstrate that using AuPd nanoparticles, which are known to have high H2O2 synthesis rates in the liquid phase, it is possible to not only oxidise organic molecules in the gas phase but to detect H2O2 for the first time as a reaction product in both a fixed bed reactor and a pulsed Temporal Analysis of Products (TAP) reactor without stabilisers present in the gas feed. This observation opens up possibility of synthesising H2O2 directly using a gas phase reaction

The direct synthesis of hydrogen peroxide using a combination of a hydrophobic solvent and water

The direct synthesis of hydrogen peroxide (H2O2) has been studied using a solvent system comprising a hydrophobic alcohol (decan-1-ol) and water. It is demonstrated that, with the optimum combination of solvent and catalyst the contribution of H2O2 degradation pathways can be minimised to achieve industrially acceptable H2O2 concentrations under moderate conditions. This is achieved through the use of a catalyst that is retained by the organic component and the extraction of synthesised H2O2 into the aqueous phase, consequently limiting contact between the synthesised H2O2, catalyst and reactant gases, resulting in an improved selectivity towards H2O2. Investigation of the reaction parameters provides an insight into the proposed solvent system, and optimised conditions to produce H2O2 from molecular H2 and O2 have been identified. Through this optimisation H2O2 concentrations up to 1.9 wt% have been achieved via sequential gas replacement experiments

A new class of Cu/ZnO catalysts derived from zincian georgeite precursors prepared by co-precipitation

Zincian georgeite, an amorphous copper-zinc hydroxycarbonate, has been prepared by co-precipitation using acetate salts and ammonium carbonate. Incorporation of zinc into the georgeite phase and mild ageing conditions inhibits crystallisation into zincian malachite or aurichalcite. This zincian georgeite precursor was used to prepare a Cu/ZnO catalyst, which exhibits a superior performance to a zincian malachite derived catalyst for methanol synthesis and the low temperature water-gas shift (LTS) reaction. Furthermore, the enhanced LTS activity and stability in comparison to that of a commercial Cu/ZnO/Al2O3 catalyst, indicates that the addition of alumina as a stabiliser may not be required for the zincian georgeite derived Cu/ZnO catalyst. The enhanced performance is partly attributed to the exclusion of alkali metals from the synthesis procedure, which are known to act as catalyst poisons. The effect of residual sodium on the microstructural properties of the catalyst precursor was investigated further with preparations using sodium carbonate

Benzyl alcohol oxidation with Pd-Zn/TiO2: computational and experimental studies

Pd–Zn/TiO2 catalysts containing 1 wt% total metal loading, but with different Pd to Zn ratios, were prepared using a modified impregnation method and tested in the solvent-free aerobic oxidation of benzyl alcohol. The catalyst with the higher Pd content exhibited an enhanced activity for benzyl alcohol oxidation. However, the selectivity to benzaldehyde was significantly improved with increasing presence of Zn. The effect of reduction temperature on catalyst activity was investigated for the catalyst having a Pd to Zn metal molar ratio of 9:1. It was found that lower reduction temperature leads to the formation of PdZn nanoparticles with a wide particle size distribution. In contrast, smaller PdZn particles were formed upon catalyst reduction at higher temperatures. Computational studies were performed to compare the adsorption energies of benzyl alcohol and the reaction products (benzaldehyde and toluene) on PdZn surfaces to understand the oxidation mechanism and further explain the correlation between the catalyst composition and its activity

The effect of heat treatment on the performance and structure of carbon-supported Au-Pd catalysts for the direct synthesis of hydrogen peroxide

The direct synthesis of hydrogen peroxide using supported gold palladium catalysts prepared by incipient wetness impregnation is described and discussed. The effect of an acid pre-treatment step on the activated carbon support prior to the deposition of the metals, together with the effect of the calcination temperature, has been investigated. The acid pre-treated samples all show superior activity to those materials prepared with the omission of this acid pre-treatment stage. The calcination temperature affects both the re-usability and hydrogenation activity of the catalysts. Detailed characterisation using X-ray photoelectron spectroscopy and aberration-corrected scanning transmission electron microscopy is described. The enhanced activity is associated with a higher surface concentration of palladium in the acid pre-treated samples which is principally present as Pd2+. Calcination of the catalysts at 400 °C is required to achieve re-usable and stable catalysts, and this is associated with the morphology and dispersion of the metal nanoparticles. The surface ratio of Pd0/Pd2+ is found to be an important factor controlling the hydrogenation of hydrogen peroxide, and a series of controlled reduction and re-oxidation of a sample show how the Pd0/Pd2+ surface ratio can influence the relative rates of hydrogen peroxide synthesis and hydrogenation