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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Managing rainfall variability in arid rainfed agriculture using adaptive varieties and in-situ water harvesting

This investigation was to establish a water harvesting technique for adaptation to rainfall variability in rainfed sorghum production and relate it to yield in Gedarif area. A field experiment was conducted for two successive seasons (2009-2010). A split-split plot design was used to test the hypothesis that crop yield was affected by three methods of sowing representing in-situ water harvesting techniques, namely; wide level disc in rows 80 cm apart using row planter and at bottom of ridges 80 cm. Three sorghum varieties were used, Arfa Gadamak8, Wad Ahmed and Bashaer. Nitrogen fertilizer of zero and 0.5N of urea was applied. In season 2009, there was a significant difference between mean of yield of Arfa_Gadamak8 and Wad-Ahmed varieties, with the latter requiring longer time to mature. Water harvesting technique increased yield as a result of increased soil moisture content. There were high simple correlation coefficients between rainfall and grain per head, head weight and length of head. It was concluded that climate change adaptation strategies for rainfed agriculture under low rainfall conditions should consider the combination of short maturing variety such as Arfa-Gadamak8 variety and in-situ water harvesting techniques

Managing rainfall variability in arid rainfed agriculture using adaptive varieties and in-situ water harvesting

This investigation was to establish a water harvesting technique for adaptation to rainfall variability in rainfed sorghum production and relate it to yield in Gedarif area. A field experiment was conducted for two successive seasons (2009-2010). A split-split plot design was used to test the hypothesis that crop yield was affected by three methods of sowing representing in-situ water harvesting techniques, namely; wide level disc in rows 80 cm apart using row planter and at bottom of ridges 80 cm. Three sorghum varieties were used, Arfa Gadamak8, Wad Ahmed and Bashaer. Nitrogen fertilizer of zero and 0.5N of urea was applied. In season 2009, there was a significant difference between mean of yield of Arfa_Gadamak8 and Wad-Ahmed varieties, with the latter requiring longer time to mature. Water harvesting technique increased yield as a result of increased soil moisture content. There were high simple correlation coefficients between rainfall and grain per head, head weight and length of head. It was concluded that climate change adaptation strategies for rainfed agriculture under low rainfall conditions should consider the combination of short maturing variety such as Arfa-Gadamak8 variety and in-situ water harvesting techniques

Anaemia among adults in Kassala, Eastern Sudan

<p>Abstract</p> <p>Background</p> <p>The increased heterogeneity in the distribution of social and biological risk factors makes the epidemiology of anaemia a real challenge. A cross-sectional study was conducted at Kassala, Eastern Sudan during the period of January — March 2011 to investigate the prevalence and predictors of anaemia among adults (> 15 years old).</p> <p>Findings</p> <p>Out of 646, 234 (36.2%) adults had anaemia; 68 (10.5%); 129 (20.0%) and 37 (5.7%) had mild, moderate and severe anaemia, respectively. In logistic regression analyses, age (OR = 1.0, CI = 0.9–1, <it>P</it> = 0.7), rural vs. urban residency (OR = 0.9, CI = 0.7–1.3, <it>P</it> = 0.9), female vs. male gender (OR = 0.8, CI = 0.6–1.1, <it>P</it> = 0.3), educational level ≥ secondary level vs. < secondary level (OR = 1.0, CI = 0.6–1.6, <it>P</it> = 0.8) and Hudandawa vs. non-Hudandawa ethnicity (OR = 0.8, CI = 0.6–1, <it>P</it> = 0.1) were not associated with anaemia.</p> <p>Conclusion</p> <p>There was a high prevalence of anaemia in this setting, anaemia affected adults regardless to their age, sex and educational level. Therefore, anaemia is needed to be screened for routinely and supplements have to be employed in this setting.</p

Monitoring antimicrobial residues in table eggs in Aswan governorate markets and their impact on egg quality and public health

Background: Organic egg is among the most common organic foods offered for sale in Egyptian markets in recent years, and consumers buy them at a higher price because they believe organic eggs are safer and have superior nutritional value than conventional eggs. Aim: The present work aimed to monitor antimicrobial residues in brown table eggs, whether conventional or organic type, in Aswan governorate markets and assessed their physical and chemical quality and their public health hazards. Methods: Brown table egg samples (n=400 total) were randomly selected in the present study, whereas they represented two equal groups (n=200 each) including conventional eggs and organic eggs. Eggs were collected from different retail stores in Aswan governorate, Egypt. Egg samples were subjected to thorough physical and chemical quality evaluation as well as assessment of antimicrobial residues. Results: The results reported organic eggs were cleaner and had a better odor, less blood and meat spots, but smaller with more shell cracks than conventional eggs. Chemical analysis of some nutrient contents in the egg yolk revealed significantly higher nutritive values of organic eggs than that of conventional ones as the organic eggs contain significantly higher levels of vitamin A and vitamin D/D3 and significantly lower values of cholesterol, calcium, magnesium and zinc than those in conventional eggs. Disc diffusion assay has been used for monitoring antimicrobial residues in egg samples. The results have shown that all examined organic eggs were free from antimicrobial residues, while 12% and 8% of conventional egg yolk and white were positive for antimicrobial residues, respectively. Conclusion: The study concludes the higher nutritive value of organic eggs compared with the conventional type because of their significantly higher contents of vitamins A and D and their significantly lower contents of cholesterol. Moreover, organic eggs were free from antimicrobial residues which maximize their public health benefits. [Open Vet J 2023; 13(5.000): 523-531

Diachronic mapping and evaluation of soil erosion rates using RUSLE in the Bouregreg River Watershed, Morocco

Soil erosion has been severely affecting soil and water resources in semi-arid areas like the Mediterranean. In Morocco, this natural process is accelerated by anthropogenic activities, such as unsustainable soil management, overgrazing, and deforestation. With a drainage area of 395,600 ha, the Bouregreg River Watershed extends from the Middle Atlas Range (Jebel Mtourzgane) to the Sidi Mohamed Ben Abdellah (SMBA) dam reservoir south-east of Rabat. Its contrasted eco-geomorphological landscapes make it susceptible to unprecedented soil erosion due to climate change. Resulting changes in erosive dynamics led to huge amounts of solid loads transported to the catchment outlet and, thus, jeopardised the SMBA dam lifespan due to siltation. The research aims to quantify the average annual soil losses in this watershed using the Revised Universal Equation of Soil Losses (RUSLE) within a GIS environment. To highlight shifts in land use/land cover patterns and their effects on erosional severity, we have resorted to remote sensing through two Landsat 8 satellite images captured in 2004 and 2019. The C factor was combined with readily available local data regarding major erosion factors, e.g. rainfall aggressiveness (R), soil erodibility (K), topography (LS), and conservation practices (P). The helped to map the erosion hazard and determine erosion prone areas within the watershed where appropriate water and conservation measures are to be considered. Accordingly, from 2004 to 2019, average annual soil losses increased from 11.78 to 18.38 t∙ha-1∙y-1, as the watershed area affected by strong erosion (>30 t∙ha-1∙y-1) evolved from 13.57 to 39.39%

Land Use/Land Cover (LULC) Using Landsat Data Series (MSS, TM, ETM+ and OLI) in Azrou Forest, in the Central Middle Atlas of Morocco

The study of land use/land cover (LULC) has become an increasingly important stage in the development of forest ecosystems strategies. Hence, the main goal of this study was to describe the vegetation change of Azrou Forest in the Middle Atlas, Morocco, between 1987 and 2017. To achieve this, a set of Landsat images, including one Multispectral Scanner (MSS) scene from 1987; one Enhanced Thematic Mapper Plus (ETM+) scene from 2000; two Thematic Mapper (TM) scenes from 1995 and 2011; and one Landsat 8 Operational Land Imager (OLI) scene from 2017; were acquired and processed. Ground-based survey data and the normalized difference vegetation index (NDVI) were used to identify and to improve the discrimination between LULC categories. Then, the maximum likelihood (ML) classification method was applied was applied, in order to produce land cover maps for each year. Three classes were considered by the classification of NDVI value: low-density vegetation; moderate-density vegetation, and high-density vegetation. Our study achieved classification accuracies of 66.8% (1987), 99.9% (1995), 99.8% (2000), 99.9% (2011), and 99.9% (2017). The results from the Landsat-based image analysis show that the area of low-density vegetation was decreased from 27.4% to 2.1% over the past 30 years. While, in 2017, the class of high-density vegetation was increased to 64.6% of the total area of study area. The results of this study show that the total forest cover remained stable. The present study highlights the importance of the image classification algorithms combined with NDVI index for better understanding the changes that have occurred in this forest. Therefore, the findings of this study could assist planners and decision-makers to guide, in a good manner, the sustainable land development of areas with similar backgrounds

Assessing Regional Scale Water Balances through Remote Sensing Techniques: A Case Study of Boufakrane River Watershed, Meknes Region, Morocco

This paper aims to develop a method to assess regional water balances using remote sensing techniques. The Boufakrane river watershed in Meknes Region (Morocco), which is characterized by both a strong urbanization and a rural land use change, is taken as a study case. Firstly, changes in land cover were mapped by classifying remote sensing images (Thematic Mapper, Enhanced Thematic Mapper Plus and Operational Land Imager) at a medium scale resolution for the years 1990, 2003 and 2018. By means of supervised classification procedures the following land cover categories could be mapped: forests, bare soil, arboriculture, arable land and urban area. For each of these categories a water balance was developed for the different time periods, taking into account changing management and consumption patterns. Finally, the land cover maps were combined with the land cover specific water balances resulting in a total water balance for the selected catchment. The procedure was validated by comparing the assessments with data from water supply stations and the number of licensed ground water extraction pumps. In terms of land use/land cover changes (LULCC), the results showed that urban areas, natural vegetation, arboriculture and cereals increased by 183.74%, 12.55%, 34.99 and 48.77% respectively while forests and bare soils decreased by 78.65% and 16.78% respectively. On the other hand, water consumption has been increased significantly due to the Meknes city growth, the arboriculture expansion and the new crops’ introduction in the arable areas. The increased water consumption by human activities is largely due to reduced water losses through evapotranspiration because of deforestation. Since the major part of the forest in the catchment has disappeared, a further increase of the water consumption by human activities can no longer be offset by deforestation.status: publishe