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

Analysis of Lake Ontario Lower Aquatic food web Assessment (LOLA 2003 and 2008) within the context of long-term ecological change

Lake Ontario is the 13th largest lake in the world with a surface area of 18,500 km² (Reynolds et al. 2000), has a population in the watershed of over 8 million, and provides a range of ecosystem services to the people in the watershed (freshwater for various uses, shipping, fisheries, and recreation). Currently, extensive surveys for each Great Lake occur on a rotating five-year schedule. This report presents the status of Lake Ontario’s lower trophic levels in 2008 and a detailed comparison with similarly collected in 2003 and with data collected by the collaborating agencies and Cornell University and discuss observed changes in relation to changes in nutrient concentration and food web configuration in Lake Ontario. There has been a spatial restructuring of the Lake Ontario offshore ecosystem through the increase in the deep chlorophyll layer and associated zooplankton. This has resulted in a Lake Ontario that in 2008 is more similar to Lakes Superior, Huron and Michigan than to the Lake Ontario of the 1990s. Major findings are Nutrients: Spring offshore total phosphorus and soluble reactive phosphorus increased from 2003 to 2008, but summer levels did not. Lake-wide average total phosphorus levels remained at or below the target level of 10 µg/L in all three seasons of 2008. Lake-wide nutrient concentrations have declined since the 1960s. However, phosphorus concentrations have been stable (~7-10 µg/L) since the mid-1990s. Spring silica was similar in 2003 and 2008 and was depleted by the summer in both years. This indicates continued spring diatom production in Lake Ontario. Phytoplankton: Summer epilimnetic chlorophyll-a increased by a factor of 2, the proportion of autotrophic algae increased, and summer water clarity declined from 2003 to 2008. Summer chlorophyll-a levels in 2008 were similar to the concentrations in the 1981-1995 time period. However, the trend towards mesotrophy in the summer of 2008 may be limited to that year as it was not followed by increased values in 2009 to 2011. Most of the chlorophyll in the water column was located in a deep chlorophyll layer in the thermocline. Zooplankton: Offshore epilimnetic zooplankton density and biomass declined from 2003 to 2008 by a factor of 5 to 12 in the summer and by a factor of 1.5 to 2.6 in the fall. This is consistent with long-term trends of declining epilimnetic zooplankton abundance including a larger decline in 2004-2005 coincident with an increase in the predatory Bythotrephes. Whole water column zooplankton density also declined from 2003 to 2008 in the summer and fall, but zooplankton biomass only declined in the fall. Large changes in whole water column zooplankton community composition occurred between 2003 and 2008 from a cyclopoid/bosminid dominated system in 2003 to a calanoid dominated system in 2008. Mysids, Diporeia and Mussels Mysid densities were similar in 2003 and 2008 indicating continued high biomass of mysids in Lake Ontario. In July of 2008, the biomass of Mysis diluviana was 17% of the crustacean zooplankton biomass in the offshore of Lake Ontario (depth >30m). Mysid densities appear stable in Lake Ontario. The native benthic amphipod Diporeia declined further in 2008 and is almost extirpated from Lake Ontario. Quagga mussels are very abundant as deep as 90 m, but populations in shallow water declined from 2003 to 2008. Few zebra mussels were present in either 2003 or 2008.Report for the GLRI funded project Improving Lake Ontario Environmental Management Decisions (Grant ID # 97220700-0

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality