Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Overview of Cloud Computing

This book serves to fill a void in introductory textbook on cloud computing publishing. The target audience are readers with some technical background that are also interested in the business aspects of cloud computing. The book intentionally does not focus on technical details and does not include step-by-step instructions in order to avoid becoming obsolete too quickly. While new tools and concepts are sure to continue to come up at a rapid pace, the bulk of the book should remain true and useful for a number of years. Examples are usually based on the Google Cloud Platform, but the principles covered in the book are equally relevant to users of other cloud platforms

Feedforward design for flexible systems : application to a 4th order motion system

This work presents a survey of feedforward design. We will show why is important for motion systems the use feedforward, present an overview of different feedforward techniques (model inversion, command shaping, jerk derivative, spatial, multi input inverse dynamics and learning control). In the second part of the report, inverse model techniques will be shown on three example systems in simulation. These systems are a single mass, mass-spring-damper , and a two mass system with flexible shaft. The first system will introduce to feedforward basis, the second to model inversion benefits in tracking error reduction and the last one is a commonly used system that will lay foundation to the real set up experiments. With the real two-mass set up we will prove that when using feedback control in one of the masses movement and feedforward control in the other, the feedback signal deteriorates the performance of the mass controlled by feedforward. At the end a technique will be presented to reduce both errors implementing a filter to create a special reference profile for the feedback control and another one for the feedforward controller

Simulation of lung alveolar epithelial wound healing in vitro

The mechanisms that enable and regulate alveolar type II (AT II) epithelial cell wound healing in vitro and in vivo remain largely unknown and need further elucidation. We used an in silico AT II cell-mimetic analogue to explore and better understand plausible wound healing mechanisms for two conditions: cyst repair in three-dimensional cultures and monolayer wound healing. Starting with the analogue that validated for key features of AT II cystogenesis in vitro, we devised an additional cell rearrangement action enabling cyst repair. Monolayer repair was enabled by providing ‘cells’ a control mechanism to switch automatically to a repair mode in the presence of a distress signal. In cyst wound simulations, the revised analogue closed wounds by adhering to essentially the same axioms available for alveolar-like cystogenesis. In silico cell proliferation was not needed. The analogue recovered within a few simulation cycles but required a longer recovery time for larger or multiple wounds. In simulated monolayer wound repair, diffusive factor-mediated ‘cell’ migration led to repair patterns comparable to those of in vitro cultures exposed to different growth factors. Simulations predicted directional cell locomotion to be critical for successful in vitro wound repair. We anticipate that with further use and refinement, the methods used will develop as a rigorous, extensible means of unravelling mechanisms of lung alveolar repair and regeneration

An Integrated All-Atlantic Ocean Observing System in 2030

The ocean plays a vital role in the global climate system and biosphere, providing crucial resources for humanity including water, food, energy, and raw materials. There is a compelling need to develop an integrated basin-scale ocean observing system to support of ocean management. We articulate a vision for basin-scale ocean observing – A comprehensive All-Atlantic Ocean Observing Systems that benefits all of us living, working and relying on the ocean. Until now, basin-scale ocean observation has been conducted through loosely-aligned arrangements of national and international efforts. The All-Atlantic Ocean Observing System (AtlantOS) is an integrated concept for a forward-looking framework and basin-scale partnership to establish a comprehensive ocean observing system for the Atlantic Ocean as a whole. The system will be sustainable, multi-disciplinary, multi-thematic, efficient, and fit-for-purpose. Platforms, networks, and systems do already exist that operate at various maturity levels. AtlantOS will go beyond the status quo by bringing together the observing communities and countries of the Atlantic basin, providing the opportunity to join and support the system. AtlantOS will build upon the coordinated work of the Global Ocean Observing System (GOOS) and the Group on Earth Observations (GEO), two international bodies that support and coordinate global ocean observing. AtlantOS will complement those efforts and offers a new approach to organizing ocean observing at the basin-scale. AtlantOS will focus not only on the physics but also the biology, ecology and biogeochemistry of the ocean and seafloor and will enhance new partnerships among governments, science, civil society and the private sector