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

Early Cretaceous counterclockwise rotation of Northeast Africa within the equatorial zone: Paleomagnetic study on Mansouri ring complex, Southeastern Desert, Egypt

The Mansouri ring complex (132 Ma) is, paleomagnetically, studied to shed light on the paleo-tectonic position of Northeast Africa during the Early Cretaceous. Progressive thermal demagnetization of all samples verified a general bi-vectorial decay of the natural remanence. After the removal of the present-day field overprint, the decaying anchored component was either: 1. A dual-polarity, shallow NW–SE directed component residing in magnetite (400–585 °C) of shiny fresh samples, or, 2. A normal-polarity, medium-inclination, north-oriented component stored in haematite of few reddish ferruginous sites. This component was considered as chemical remagnetization carried by secondary haematite. Due to its steady stability, overwhelming existence in most sites, positive reversal test and its residence in fresh-samples’ magnetite, the first dual-polarity, shallow NW–SE component, was considered as the characteristic remanent magnetization [ChRM] representing the paleomagnetic field during cooling of the Mansouri ring complex. The mean paleomagnetic pole of the isolated ChRM was at 47°N/259°E, Dp/Dm = 3.4°/6.6°. This Hauterivian pole from Egypt shows reasonable consistency with its coeval poles rotated from the main tectonic units to Northeast Africa. It reveals that in Early Cretaceous: 1. Northeast Africa was equatorial, lying just south the Equator. Cairo, which is now at 30°N, was at −1.5° paleo-latitude. 2. The Azimuth of the African Plate was NE–SW, about 30° clockwise with respect to the present-day N–S trend. Comparing this Hauterivian pole to that of the Wadi Natash basalts [107 ± 4 Ma], which was at [55°N/250°E] during the Albian, the African Plate seems to have rotated counter-clockwise about 10° with Northeast Africa moving northwards [Cairo was moving from 1.5°S to 1.5°N] within the equatorial zone, during the Early Cretaceous

Paleo-tectonic positions of Northeast Africa d

The middle/late Paleocene basalts which cover the Late Cretaceous sandstone in the East Gilf Kebir Plateau were sampled for paleomagnetic investigation. The progressive thermal demagnetization revealed that − The hematite component was parallel to the present-day field and the goethite overprint. Its pole is considered as representing recent low-temperature martitization of the magnetite upon exposure to intensive chemical alteration. − The magnetite-anchored component was N–S dual-polarity with shallow equatorial inclinations. Based on its overwhelming existence, this component was considered as the characteristic remanence of the sampled basalt. Its north pole (71.7°N/203.5°E) was considered as representing the geomagnetic field during the eruption of the basalt. The reliability of the East Gilf Kebir basalt (59 ± 1.7 Ma) pole was constrained by its comparison with synchronous poles rotated from the main tectonic units using Euler Pole rotation. This basalt pole places NE Africa, along its present N–S azimuth at a far south tropical paleo-latitude. Cairo [30°N], was at paleo-latitude 11.8°N in middle/late Paleocene (59 Ma), that is about 18° south to its present-day latitude. Comparing the present pole with the Mansouri ring complex (132 ± 10 Ma) Early Cretaceous pole (47°N/259°E) and two poles from the Wadi Natash volcanic field; the alkali basalt (104 ± 7 Ma) Middle Cretaceous pole [55°N/250°E] and the trachyte/Phonolite (86–78 Ma) Late Cretaceous pole [66.5°N/229°E], a Cretaceous–Paleocene segment [132–59 Ma] of the Apparent Polar Wander Path [APWP] of Africa could be traced. These poles can, concurrently, verify the paleo-azimuth and paleo-latitude evolution of the African plate during the Cretaceous and Paleocene

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially