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

Evaluation and Mitigation of Flash Flood Risks in Arid Regions: A Case Study of Wadi Sudr in Egypt

Flash floods threaten the lives of people and properties in different regions around the world, especially in arid and semi-arid regions due to infrequent flood events. The current study aims to assess the geomorphological parameters of Wadi Sudr, South Sinai in Egypt to evaluate flash flood risks and provide adequate mitigation methods. This study presents an integrated method that combines geographic information system (GIS) and watershed modeling system (WMS) with HEC-HMS to visualize and assess flood events in the study area. Different morphologic parameters of the watershed were determined, including linear, areal, and relief parameters. GIS was used to analyze the satellite images and determine the characteristics of the valley to get the extension and number of stream orders in the valley, then WMS was used to estimate rainstorms and basin characteristics, as well as estimate the amount of rain that causes flooding. HEC-HMS program was used for hydrological demonstration and precipitation overflow estimation. The morphometric analysis provided a quantitative portrayal of the Wadi Sudr watershed. Wadi Sudr has 4029 streams connected with seventh order of streams spread over an area of 547.45 km2. Based on the results of morphologic and hydraulic parameters of the watershed, two locations of protection dams were suggested. A comparison between the two locations was made to select the best location based on some criteria, including storage capacity, water depth behind the dam, width and shape of the valley, and the area covered by water stored in the reservoir. The comparison between the two locations showed that the first location is more appropriate for dam construction based on the examined criteria. The valley shape in the first location is more regular than in the second. The first location provided higher storage capacity and water depth in front of the dam than the second. The area covered by water and the width of the valley is less than the second. The stability of the dam at the first site could be higher and the cost of construction could cost be less than the second due to these reasons. A comparison was made using the weighted linear combination (WLC) method, which consists of 13 criteria to determine the suitability index (SI) in order to select the best location from the proposed locations. SI proved that the first location is better than the second. The designed dam in the selected site could be cost-efficient to protect the study area from flood risks and harvesting water that can be used in different purposes. This methodology can be applied in different areas for mitigating flash flood risks

Evaluation and Mitigation of Flash Flood Risks in Arid Regions: A Case Study of Wadi Sudr in Egypt

Flash floods threaten the lives of people and properties in different regions around the world, especially in arid and semi-arid regions due to infrequent flood events. The current study aims to assess the geomorphological parameters of Wadi Sudr, South Sinai in Egypt to evaluate flash flood risks and provide adequate mitigation methods. This study presents an integrated method that combines geographic information system (GIS) and watershed modeling system (WMS) with HEC-HMS to visualize and assess flood events in the study area. Different morphologic parameters of the watershed were determined, including linear, areal, and relief parameters. GIS was used to analyze the satellite images and determine the characteristics of the valley to get the extension and number of stream orders in the valley, then WMS was used to estimate rainstorms and basin characteristics, as well as estimate the amount of rain that causes flooding. HEC-HMS program was used for hydrological demonstration and precipitation overflow estimation. The morphometric analysis provided a quantitative portrayal of the Wadi Sudr watershed. Wadi Sudr has 4029 streams connected with seventh order of streams spread over an area of 547.45 km2. Based on the results of morphologic and hydraulic parameters of the watershed, two locations of protection dams were suggested. A comparison between the two locations was made to select the best location based on some criteria, including storage capacity, water depth behind the dam, width and shape of the valley, and the area covered by water stored in the reservoir. The comparison between the two locations showed that the first location is more appropriate for dam construction based on the examined criteria. The valley shape in the first location is more regular than in the second. The first location provided higher storage capacity and water depth in front of the dam than the second. The area covered by water and the width of the valley is less than the second. The stability of the dam at the first site could be higher and the cost of construction could cost be less than the second due to these reasons. A comparison was made using the weighted linear combination (WLC) method, which consists of 13 criteria to determine the suitability index (SI) in order to select the best location from the proposed locations. SI proved that the first location is better than the second. The designed dam in the selected site could be cost-efficient to protect the study area from flood risks and harvesting water that can be used in different purposes. This methodology can be applied in different areas for mitigating flash flood risks

Assessment of Dams’ Failure and Flood Wave Hazards on the Downstream Countries: A Case Study of the Grand Ethiopian Renaissance Dam (GERD)

Dams are built for different purposes, but failure of a dam could result in extreme disasters such as floods. The Grand Ethiopian Renaissance Dam (GERD) was mainly built for power generation, but concerns about its safety, location and site conditions have led the downstream countries to investigate the GERD’s stability. This paper aims to investigate the impact of the failure of the dam on the downstream countries using the Hydrologic Engineering Center River Analysis System (HEC-RAS). Outflow hydrographs and flood inundation maps were provided through a hypothetical dam break scenario. An unsteady flow hydrodynamic routing with a 2D model was used to simulate the failure of the dam. A sensitivity analysis study of the output’s findings against breach parameters was also performed. The breach outflow discharge increases as the breach dimension increases. However, the peak discharge decreases with increasing breach formation time. Moreover, to prepare emergency action plans, it is important to predict the inundation depth, levels, arrival of flood waves, flood coverage area and water velocity. Furthermore, the results showed that Khartoum would turn into lakes within about 10 days and flood water depth would exceed 11 m at some locations in residential areas. Moreover, the flood waves overtopped the Roseires, Sennar and Merowe dams by 11, 7 and 20 m, respectively. In addition, the level of Lake Nasser would reach 188 m above sea level and the Aswan High Dam might be in great danger

Systematic Review on the Efficacy, Effectiveness, Safety, and Immunogenicity of Monkeypox Vaccine

Background: The variation in the reported vaccine safety and effectiveness could contribute to the high rates of vaccine hesitancy among the general population and healthcare workers in areas where monkeypox (mpox) is circulating. In this review, our objective was to evaluate the safety, immunogenicity, effectiveness, and efficacy of the mpox vaccines. Methods: An extensive search for articles across multiple databases was performed, including searching six databases (PubMed Central, PubMed Medline, Scopus, Web of Science, Cochrane, ProQuest), two pre-print databases (European PMC Preprint and MedRxiv), and Google Scholar. Results: A total of 4290 citations were retrieved from the included databases. Following the removal of duplicates and the initial screening of records, a total of 36 studies were included into the analysis. Additionally, we identified five more studies through manual searches, resulting in a total of 41 eligible articles for qualitative synthesis. The study findings revealed that mpox vaccines demonstrate the ability to generate adequate antibodies; however, their effectiveness may decrease over time, exhibiting varying safety profiles. Most of the included studies consistently reported substantial levels of effectiveness and efficacy against mpox. Interestingly, the number of vaccine doses administered was found to influence the degree of immunogenicity, subsequently impacting the overall effectiveness and efficacy of the vaccines. Furthermore, we found that smallpox vaccines exhibited a form of cross-protection against mpox. Conclusions: Vaccines can be used to prevent mpox and effectively control its spread

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