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

Rapid detection of resistance to carbapenems and cephalosporins in Enterobacteriaceae using liquid chromatography tandem mass spectrometry.

Carbapenemase producing Enterobacteriaceae (CPE) are becoming a global healthcare concern. Current laboratory methods for the detection of CPE include screening followed by confirmatory phenotypic and genotypic tests. These processes would generally take ≥72 hours, which could negatively impact patient care and Infection Control practices. To this end, we developed a protocol for rapid resistance testing (RRT) to detect hydrolysis in a panel of beta lactam antibiotics consisting of ampicillin, cefazolin, cefotaxime and imipenem, using liquid chromatography tandem mass spectrometry. Ninety-nine beta lactamase producing Enterobacteriaceae isolates were used to evaluate the RRT method, 54 isolates were CPE and 45 isolates were Class A or AmpC beta lactamase producing Enterobacteriaceae but not carbapenemase producers. We also tested 10 E.coli isolates that were susceptible to ampicillin, cefazolin, cefotaxime and imipenem. Receiver Operating Characteristic (ROC) Curves analysis showed that imipenem had a sensitivity and a specificity of 100% for crabapenemase detection at hydrolysis cut off values that are greater than 50% and less than or equal to 80%. The RRT protocol can be conducted in a time frame of less than 2 hours. This preliminary study shows that the rapid resistance testing protocol might have utility for the rapid detection of CPE. Additional work with a greater number and variety of beta- lactamase producing Enterobacteriaceae isolates is required to validate these preliminary findings

Agriculture, environment and food security

The 18th century Malthusian prediction of population growth outstripping food production have not yet come to bear. Unprecedented agricultural land expansion since 1700, and technological innovations from the Green Revolution of the 1950s, have enabled more calorie production per capita than was ever available before in history. This remarkable success, however, has come at a great cost. Agriculture is a major cause of global environmental degradation. Undernourishment and micronutrient deficiencies persist among large parts of the population, and a new epidemic of obesity is on the rise. We review both the successes and failures of the global food system, addressing ongoing debates on pathways to environmental health and food security. To deal with these challenges, a new coordinated research program blending modern breeding with agro-ecological methods is needed. We call on plant biologists to lead this effort, and help steer humanity toward a “safe operating space” for agriculture.Science, Faculty ofOther UBCNon UBCBotany, Department ofResources, Environment and Sustainability (IRES), Institute forReviewedFacultyResearcherPostdoctora

Tackling policy leakage and targeting hotspots could be key to addressing the ‘Wicked’ challenge of nutrient pollution from corn production in the U.S.

Reducing nutrient loss from agriculture to improve water quality requires a combination of management practices. However, it has been unclear what pattern of mitigation is likely to emerge from different policies, individually and combined, and the consequences for local and national land use and farm returns. We address this research gap by constructing an integrated multi-scale framework for evaluating alternative nitrogen loss management policies for corn production in the US. This approach combines site- and practice-specific agro-ecosystem processes with a grid-resolving economic model to identify locations that can be prioritized to increase the economic efficiency of the policies. We find that regional measures, albeit effective in reducing local nitrogen loss, can displace corn production to the area where nitrogen fertilizer productivity is low and nutrient loss rate is high, thereby offsetting the overall effectiveness of the nutrient management strategy. This spatial spillover effect can be suppressed by implementing the partial measures in tandem with nationwide policies. Wetland restoration combined with split fertilizer application, along with a nitrogen loss tax could reduce nitrate nitrogen loss to the Mississippi River by 30% while only increasing corn prices by less than 2%

Measuring the working experience of doctors in training

Using an online tool, we report the association between tasks and ‘affect’ (underlying experience of feeling, emotion or mood) among 565 doctors in training, how positive and negative emotional intensity are associated with time of day, the extent to which positive affect is associated with breaks, and consideration about leaving the profession. Respondents spent approximately 25% of their day on paperwork or clinical work that did not involve patients, resulting in more negative emotions. Positive emotions were expressed for breaks, staff meetings, research, learning and clinical tasks that involved patients. Those having considered leaving the profession report more negative feelings. Systematic workplace changes (regular breaks, reducing paperwork and improved IT systems) could contribute to positive workday experiences and reduce intention to quit. Educators and employers have important roles in recognising, advocating for and implementing improvements at work to enhance wellbeing with potential to improve retention of doctors in training

A World at Risk: Aggregating Development Trends to Forecast Global Habitat Conversion

<div><p>A growing and more affluent human population is expected to increase the demand for resources and to accelerate habitat modification, but by how much and where remains unknown. Here we project and aggregate global spatial patterns of expected urban and agricultural expansion, conventional and unconventional oil and gas, coal, solar, wind, biofuels and mining development. Cumulatively, these threats place at risk 20% of the remaining global natural lands (19.68 million km²) and could result in half of the world’s biomes becoming >50% converted while doubling and tripling the extent of land converted in South America and Africa, respectively. Regionally, substantial shifts in land conversion could occur in Southern and Western South America, Central and Eastern Africa, and the Central Rocky Mountains of North America. With only 5% of the Earth’s at-risk natural lands under strict legal protection, estimating and proactively mitigating multi-sector development risk is critical for curtailing the further substantial loss of nature.</p></div

Projected future development threat of coal.

<p>Area-ranked threat scores based on coal basin reserve estimates in million short tons attributed form country- and state-level coal reserve data.</p

Projected future development threat of unconventional oil and gas.

<p>Area-ranked threat scores based on basin-level estimates of technically recoverable billion barrels of oil equivalent for unconventional oil, natural gas, and liquid natural gas resources.</p